钱艳清++++++马大正++++++孙云

[摘要] 目的 探讨补肾疏肝方治疗肾虚肝郁型复发性流产的临床效果。 方法 选取2015年7月～2016年11月在温州市中医院治疗的肾虚肝郁型复发性流产患者为研究对象。采用随机数字表法将受试者分为对照组和治疗组，对照组单用黄体酮注射液治疗，治疗组给予黄体酮注射液联合中药治疗。观察两组患者临床综合疗效、中医证候积分、孕囊最大径线、焦虑自评量表（SAS）评分，以及血清人绒毛膜促性腺激素（β-HCG）和孕酮水平。 结果 治疗组总有效率为88.0%，显著高于对照组（72.0%），差异有统计学意义（P < 0.05）。治疗组治疗后中医证候积分明显低于本组治疗前及对照组治疗后，差异有统计学意义（P < 0.05）。治疗后，两组患者孕囊最大径线均明显高于治疗前，且治疗组治疗后孕囊最大径线明显高于对照组，差异均有统计学意义（P < 0.05）。治疗后，治疗组患者SAS评分均明显低于治疗前，对照组SAS评分明显高于治疗前，差异均有统计学意义（P < 0.05）。治療组治疗后SAS评分显著低于对照组，差异有统计学意义（P < 0.05）。治疗组妊娠5、6周后血清孕酮水平明显低于对照组，β-HCG明显高于对照组，差异有统计学意义（P < 0.05）。两组妊娠8、10周血清孕酮、β-HCG水平比较，差异无统计学意义（P > 0.05）。 结论 补肾疏肝方可以提高肾虚肝郁型复发性流产患者的保胎成功率，改善焦虑状态，临床安全有效。

[关键词] 复发性流产；肾虚肝郁型；补肾疏肝方

[中图分类号] R714.21 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0086-04

Clinical effect of Bushen Shugan Prescription in the treatment of recurrent spontaneous abortion with syndrome of kidney deficiency and liver depression

QIAN Yanqing MA Dazheng SUN Yun

Department of Gynaecology， Traditional Chinese Medicine Hospital of Wenzhou City， Zhejiang Province， Wenzhou 325000， China

[Abstract] Objective To explore the clinical effect of Bushen Shugan Prescription in the treatment of recurrent spontaneous abortion with syndrome of kidney deficiency and liver depression. Methods The recurrent spontaneous abortion patients with syndrome of kidney deficiency and liver depression in Traditional Chinese Medicine Hospital of Wenzhou City from July 2015 to November 2016 were selected as research objects， and they were randomly divided into control group and treatment group. The control group received Progesterone Injection alone， the treatment group received Progesterone Injection combined with traditional Chinese medicine. The clinical comprehensive therapeutic effect， TCM symptom score， the max diameter line of gestational sac， self-rating anxiety scale （SAS）， and the levels of serum human chorionic gonadotropin （β-HCG）， progesterone in the two groups were observed. Results The total effective rate in the treatment group was 88.0%， which was significantly higher than that of control group （72.0%）， there was statistically significant difference （P < 0.05）. TCM syndrome score of treatment group after treatment was lower than that before treatment and that of control group after treatment， the differences were statistically significant （P < 0.05）. After treatment， the max diameter line of gestational sac of the two groups was both higher than those before treatment， and the max diameter line of gestational sac in the treatment group after treatment was higher than that of control group， the differences were statistically significant （P < 0.05）. After treatment， the SAS score of treatment group was lower than that before treatment， the SAS score of control group was higher than that before treatment， the differences were statistically significant （P < 0.05）， the SAS score of treatment group after treatment was lower than that of control group， the difference was statistically significant （P < 0.05）. After pregnancy for 5， 6 weeks， the levels of serum progesterone in the treatment group were lower than those of control group， the levels of β-HCG were higher than those of control group， the differences were statistically significant （P < 0.05）， while there were no statistically significant differences of serum progesterone， β-HCG between the two groups after pregnancy for 8， 10 weeks （P > 0.05）. Conclusion Bushen Shugan Prescription can increase the success rate of preventing miscarriages of recurrent spontaneous abortion patients with syndrome of kidney deficiency and liver depression， improve anxiety state， which is safe and effective in clinic.

[Key words] Recurrent spontaneous abortion； Syndrome of kidney deficiency and liver depression； Bushen Shugan Prescription

随着人们生存环境和生活方式的改变，复发性流产已然成为了最常见的妊娠病之一，极大地影响了妇女的身心健康和生育质量。复发性流产是一个或多个因素引起的复杂过程[1]，主要包括遗传因素、生殖器官畸形、感染因素、内分泌异常及免疫功能紊乱等。反复的流产不但增加患者的经济负担，更增加其心理负担，可产生不同程度的紧张、焦虑、抑郁、恐惧等心理变化，尤其在孕期表现更为明显，甚至可导致再次自然流产的发生[2]。在实际临床中，自古以来许多医家多以补肾益气为基础，同时兼顾疏肝理气，使肾气更旺，胎元更固，在辨证论治的前提下，可将补肾益精固胎类药物与部分柔肝疏肝类药物一起合理配伍应用[3]。……