程慧琴+陆珺+王珺+刘辉

摘 要 目的：探索中医辩证论治方法在社区先兆流产孕妇管理中的应用。方法：选择2013年6月-2014年6月社区早孕管理过程中发现的先兆流产孕妇95例，分为干预组49例和对照组46例。对照组实行常规孕产妇方法管理，干预组在常规孕产妇管理基础上应用中医辨证论治治疗先兆流产。跟踪随访至两组孕妇产后，对孕妇心理、时间消耗、经济消耗和妊娠结局进行评估。结果：干预组治疗时间、治疗总费用低于对照组（P<0.05）；两组流产率相比差异无统计学意义（P>0.05）；干预组抑郁、焦虑评分显著低于对照组（P<0.05）。结论：中医辨证论治的合理应用能减少社区先兆流产孕妇的心理负担，降低经济消耗、时间消耗，保证良好的妊娠结局。

关键词 先兆流产 辨证论治 孕妇管理

中图分类号：R714.2/R241 文献标识码：A 文章编号：1006-1533（2016）16-0039-03

Application effect of dialectical treatment of Chinese medicine in the management of threatened abortion women in the community

CHENG Huiqin1， LU Jun2， WANG Jun3， LIU Hui1（1. Daqiao Community Health Service Centre of Yangpu District， Shanghai 200090， China； 3. Shanghai Maternal and Child Health Care Center， Shanghai 200062， China； 3. The Second Peoples Hospital in Hami district， Xinjiang Uygur Autonomous Region 839000， China）

ABSTRACT Objective： To explore the application effect of the dialectical treatment of Chinese medicine in the management of threatened abortion women in the community. Methods： From June 2013 to June 2014， 95 pregnant women with threatened abortion were selected and randomly divided into an intervention group with 49 cases and a control group with 46 cases. The control group was managed with the routine maternal method. The intervention group was treated with TCM syndrome differentiation for threatened abortion on the basis of routine maternal management. Both groups were followed up till to pregnant women postpartum， and their psychology， time consumption， economic consumption and pregnancy outcome were evaluated. Results： The treatment time and total cost of the intervention group was lower than those of the control group （P<0.05）. There was no significant difference in abortion rates between the two groups （P>0.05）. The scores of depression and anxiety in the intervention group were significantly lower than those in the control group （P<0.05）. Conclusion： The reasonable application of TCM syndrome differentiation and treatment in the community threatened abortion can reduce the psychological burden of the community threatened abortion， reduce its economic and time consumptions， and ensure the good pregnancy outcome.

KEY WORDS threatened abortion； syndrome differentiation； maternal management

本研究搭借中医药在社区大力推广使用的平台，结合社区管理特色，探索将中医药技术与社区孕产妇管理相结合，对社区先兆流产孕产妇进行综合管理的疗效与可行性。

1 资料与方法

1.1 研究对象

选取2013年6月—2014年6月大桥街道先兆流产的早孕妇95例，纳入标准：①大桥街道常住孕产妇，社区卫生服务中心（中心）早孕建卡者；②符合先兆流产诊断孕妇；③愿意接受社区中医药辩证施治，并配合随访者；④无其他基础疾病者。排除标准：①非本街道常住孕产妇，外院中医药治疗的除外；②依从性差，不愿意接受社区中医药辩证施治者；③合并有其他基础疾病者。将研究对象分为干预组49例，对照组46例。

1.2 干预方法

干预组：先兆流产孕妇在中心建卡或前来就诊时，在实行常规孕产妇管理（完成建卡、早孕筛查，孕期随访）的同时，结合中医辨证论治法给予相应保胎治疗，即给予西药黄体酮+中医辨证论治处理，参照《上海市中医病证诊疗常规》[1]，给予辨证分型及辨证施治：①肾气不足证：固肾健脾，养血安胎，方如寿胎丸加味。……