张丽 唐积春 高宏杰

摘要 目的：探討益气化瘀汤联合黄体酮治疗药物流产后阴道出血的临床疗效及对孕酮（P）、雌二醇（E2）的影响。方法：选取2018年3月至2021年1月北京中西医结合医院期间收治的药物流产后阴道出血患者102例作为研究对象，按照随机数字表法分为对照组和观察组，每组51例。对照组给予黄体酮治疗，观察组在此基础上联合益气化瘀汤治疗。比较2组治疗前后激素指标及中医证候积分变化，治疗后出血控制及月经恢复情况;分析其疗效与不良反应。结果：与对照组总有效率（82.35%）比较，观察组（96.08%）更高（P<0.05）;观察组治疗后阴道出血持续时间、月经复潮时间短于对照组，阴道出血量与月经复潮量均低于对照组（P<0.05）;2组治疗前激素水平、中医证候积分比较差异无统计学意义（P>0.05），治疗后观察组E2水平高于对照组，P、β-人绒毛膜促性腺激素（β-HCG）、中医证候积分均低于对照组（P<0.05）;与对照组不良反应发生率（19.61%）比较，观察组（3.92%）更低（P<0.05）。结论：对药物流产后阴道出血患者采取益气化瘀汤联合黄体酮治疗的临床效果较好，可有效改善激素水平和症状，促进子宫恢复，减少不良反应发生，安全有效。

关键词 益气化瘀汤;黄体酮;药物流产;阴道出血;孕酮;雌二醇;临床疗效;中医证候积分

Clinical Study of Yiqi Huayu Decoction Combined with Progesterone in the Treatment of Vaginal Bleeding after Drug Abortion

ZHANG Li1，TANG Jichun2，GAO Hongjie3

（1 Obstetrics and Gynecology Department of Beijing Hospital of Integrated Traditional Chinese and Western Medicine，Beijing 100039，China; 2 Obstetrics and Gynecology Department of Penglai Hospital of traditional Chinese Medicine，Penglai 265600，China; 3 Institute of Information on Traditional Chinese Medicine，China Academy of Chinese Medical Sciences，Beijing 100700，China）

Abstract Objective：This paper investigated the clinical efficacy of Yiqi Huayu Decoction combined with progesterone in the treatment of vaginal bleeding after drug abortion and the influence on progesterone and estradiol.Methods：A total of 102 patients with vaginal bleeding after medical abortion who were admitted to Beijing Hospital of Integrated Traditional Chinese and Western Medicine from March 2018 to January 2021 were divided into the control group and observation group according to the random number table method，51 in either group.The control group was treated with progesterone，and the treatment group with Yiqi Huayu Decoctio and progesterone.The changes in hormone indicators and TCM symptom score before and after treatment were compared between the two groups，and bleeding control and menstruation recovery after treatment，the curative effect，and occurrence of adverse reactions were analyzed.Results：The total effective rate of the treatment group was higher than that of the control group（96.08% vs.82.35%）（P<0.05）.The duration of vaginal bleeding and the time of menstruation recovery in the treatment group were shorter than those in the control group，and the amount of vaginal bleeding and menstrual blood volume in the treatment group were less than those in the control group（P<0.05）.The hormone levels and TCM syndrome scores were insignificantly different between the two groups before treatment（P>0.05）.After treatment，the estradiol level in the treatment group was higher，and levels of progesterone and human chorionic gonadotropin β（β-HCG） and TCM syndrome score were lower in the treatment group than in the control group（P<0.05）.The incidence of adverse reactions in the treatment group was lower than that in the control group（3.92% vs.19.61%）（P<0.05）.Conclusion：For patients with vaginal bleeding after medical abortion，the clinical effect of Yiqi Huayu Decoction combined with progesterone is better.It can effectively improve hormone levels and symptoms，promote uterine recovery，reduce adverse reactions，which is safe and effective.9B12DC1F-370B-4794-9480-D09E4858E9C6

Keywords Yiqi Huayu Decoction; Progesterone; Medical abortion; Vaginal bleeding; Progesterone; Estradiol; Clinical effect; TCM syndrome score

中图分类号：R169.42文献标识码：Adoi：10.3969/j.issn.1673-7202.2022.08.016

药物流产是避孕失败后较常用的一种妊娠终止方法，具有操作简单，患者接受度高的特点[1]。西药多采取口服黄体酮治疗，作为女性体内所分泌的主要孕激素，黄体酮可有效迅速修复患者子宫内膜，对药物流产后出血有一定的治疗效果，但单独用药的治疗效果并不理想[2]。药物流产容易引起患者出现妊娠产物滞留等情况，如阴道出血、腰腹痛及尿潴留、恶露不绝和乳汁不下等并发症，严重危害广大女性的身心健康。而流产后阴道出血多因药物引起冲任不调和气血不足，气血运行不畅，从而出现瘀血内滞的情况，该类患者会持续3周以上有阴道不规则出血，为此如何预防阴道出血并发症具有重要的临床意义[3]。……