陈曦　沈维增

[摘要] 目的 探讨栀黄汤治疗母婴血型不合的临床效果。 方法 以我院2013年1月～2014年12月接收的117例母婴血型不合孕妇为研究对象，采用随机数字表法将其分为对照组（57例）及观察组（60例）。对照组给予维生素C静脉注射，500 ml/次，1次/d，维生素E口服，100 mg/次，1次/d；观察组在对照组基础上给予栀黄汤治疗，100 ml/次，2 次/d。观察比较两组治疗总有效率、不良反应发生率、治疗前后抗体效价变化及不良妊娠结局发生率。 结果 观察组患者治疗总有效率为96.67%（58/60），对照组为75.44%（43/57），观察组明显较对照组高，差异有统计学意义（χ2=11.158，P=0.001）。两组患者均未见肾功能损害、血小板减少等严重不良反应。观察组出现口干4例（6.67%），对照组为1例（1.75%），均自行缓解，观察组不良反应发生率高于对照组，但差异无统计学意义（χ2=1.724，P=0.198）。治疗前，两组患者抗体效价比较差异无统计学意义（P>0.05），治疗后均有明显改善，且观察组患者治疗后抗体效价与对照组比较，明显改善，差异有统计学意义（P<0.05）。两组均未出现死胎现象，新生儿均无先天畸形发生，观察组不良妊娠结局发生率为5.00%（3/60），与对照组的14.04%（8/57）比较，明显降低，差异有统计学意义（χ2=2.801，P=0.047）。 结论 栀黄汤治疗母婴血型不合，具有疗效确切、安全性高等优点，能显著降低其抗体效价，值得临床推广应用。

[关键词] 母婴血型不合；栀黄汤；血清抗体效价；新生儿溶血

[中图分类号] R722.18 [文献标识码] A [文章编号] 1674-4721（2016）02（c）-0109-04

[Abstract] Objective To discuss the clinical effect of Zhihuang decoction in the treatment of blood type incompatibility between mother and infant. Methods 117 pregnant women with blood type incompatibility between mother and infant treated in our hospital from January 2013 to December 2014 were selected and randomly divided into the control group（n=57） and the observation group（n=60）.Patients in the control group were given vitamin C 500 ml each time，1 time 1 day，and vitamin E 100 mg each time，1 time 1 day.Patients in the observation group were additionally given Zhihuang decoction 100 ml each time，2 times 1 day.The overall response rate， incidence of adverse events，change of antibody titer before and after treatment，and incidence of adverse pregnancy outcomes were compared between two groups. Results The overall response rate in the observation group was 96.67%（58/60），and in the control group was 75.44%（43/57），which was significantly higher in the observation group（χ2=11.158，P=0.001）.No severe adverse event such as renal function damage and thrombocytopenia was observed.4 cases（6.67%） in the observation group and 1 case in the control group（1.75%） was reported thirst，and all spontaneously remitted.The incidence of adverse event was higher in the observation group than that in the control group，but it was not statistically significant（χ2=1.724，P=0.198）.There was no significant difference in the antibody titter of between two groups before treatment（P>0.05）.The antibody titters of both groups were significantly improved after treatment and it was significantly lower in the observation group than in the control group（P<0.05）.No stillbirth or congenital malformation was observed between two groups.The adverse pregnancy outcome rate in the observation group was 5.00%（3/60），which was significantly lower than the 14.04%（8/57） in the control group（χ2=2.801，P=0.047）. Conclusion Zhihuang decoction has definite therapeutic effect and high safety and can reduce the antibody titter in treatment of blood type incompatibility between mother and infant，which is worthy to be promoted.

[Key words] Blood type incompatibility between mother and infant；Zhihuang decoction；Serum antibody titer；Newborn infant hemolysis

母婴血型不合是一组与血型有关的抗原抗体免疫反应性疾病，以ABO血液系统最为常见，其不仅导致新生儿溶血症发生，还易引起孕妇流产、死胎等，因此，如何治疗母婴血型不合成为临床工作者亟待解决的问题之一。目前，西医多给予维生素C、E等提高母婴抵抗力，以预防新生儿溶血症，但是效果并不理想，中医学认为[1-3]，母体湿热互结，化为胎毒是其主要病机，而采用清热利湿的中药能有效改善母体湿热体质，本文以117例母婴血型不合孕妇为研究对象，探讨栀黄汤的临床效果。