自拟补肾活血助孕汤配合温针灸八<span style=

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摘要目的探讨自拟补肾活血助孕汤配合温针灸八髎穴治疗隐匿性原发性卵巢功能不全（POI）合并不孕症的临床效果。方法选取2017年3月～2018年12月于湖北省妇幼保健院中西医结合科就诊的60例隐匿性POI合并不孕症患者作为研究对象，按照随机字母表法将其分为三组：来曲唑组（A组）、来曲唑+雌二醇片/雌二醇地屈孕酮片复合包装（芬吗通）+阿司匹林组（B组）、来曲唑+地屈孕酮+中药+温针灸组（C组），每组各20例。A组患者单纯使用小剂量来曲唑诱导排卵；B组患者在A组的基础上于月经第10天给予雌二醇片/雌二醇地屈孕酮片复合包装（白片）1～2mg口服，排卵后72h给予雌二醇片/雌二醇地屈孕酮片复合包装（灰片）1～2片加阿司匹林肠溶片25mg，口服；C组患者在A组的基础上，于月经周期第5天给予中药自拟补肾活血助孕汤口服，并配合八髎穴行温针灸，一周2次，排卵后7 2h给予地屈孕酮片口服，1次1片，1天2次。治疗周期6个月。统计三组患者扳机日子宫内膜厚度、形态、子宫螺旋动脉血流参数[搏动指数（PI）、阻力指数（RI）、动脉收缩期峰值流速/舒张末期峰值流速（S/D）]、妊娠率以及自然流产率。结果 B组和C组患者的妊娠率均高于A组，差异有统计学意义（P＜0.05）；B组与C组患者的妊娠率比较，差异无统计学意义（P＞0.05）；三组患者的自然流产率比较，差异无统计学意义（P＞0.05）。B组和C组患者的子宫内膜厚度均高于A组，差异有统计学意义（P＜0.05）；B组与C组患者的子宫内膜厚度比较，差异无统计学意义（P＞0.05）；C组患者的子宫内膜A型占比高于A组和B组，差异有统计学意义（P＜0.05）；A组和B组患者的子宫内膜A型占比比较，差异无统计学意义（P＞0.05）。B组和C组患者的PI均低于A组，差异有统计学意义（P＜0.05）；B组与C组患者的PI比较，差异无统计学意义（P＞0.05）；B组、C组患者的RI、S/D均低于A组，且C组低于B组，差异有统计学意义（P＜0.05）。结论中药及针灸配合，能够明确改善子宫内膜厚度、子宫动脉血流参数，并能提高隐匿性POI合并不孕症患者的临床妊娠率。

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关键词 ：隐匿性原发性卵巢功能不全, 妊娠率, 子宫动脉血流参数, 子宫内膜容受性, 八髎穴, 口服中药

Abstract：Objective To investigate the clinical effect of self-made Bushen Huoxue Zhuyun Decoction combined with warm acupuncture at Baliao acupoint in the treatment of occult primary ovarian insufficiency (POI)with infertility.Methods Sixty patients with occult POI combined with infertility who were treated in the Department of Integrated Traditional Chinese and Western Medicine of HubeiMaternal and Child Health Hospital from March 2017 to December 2018 were selected as the research objects,and they were divided into three groups according to the random alphabet:Letrozole group(group A),Letrozole+Complex Packing Estradiol Tablets/Estradioland Dydrogesterone Tablets(Fenmorphone)+Aspirin group(group B)and Letrozole+Dydrogesterone+Chinesemedicine+warm acupuncture group(group C),20cases in each group.Patients in group A simply used low-dose Letrozole to induce ovulation.Patients in group B were given Complex Packing Estradiol Tablets/Estradioland Dydrogesterone Tablets(white tablets)1to 2mg orally on the tenth day ofmenstruation on the basis of group A,and given Complex Packing Estradiol Tablets/Estradioland Dydrogesterone Tablets(gray tablets)1to 2tablets plus Aspirin Enteric-coated Tablets 25mg for oral administration at 72hours after ovulation.On the basis of group A,the patients in group C were given Chinese medicine self-made Bushen Huoxue Zhuyun Decoction on the fifth day of themenstrual cycle,combined with warm acupuncture at Baliao acupoint twice a week,and given Dydrogesterone Tablets orally 72hours after ovulation,1tabletat a time,twice a day.The treatment period was 6months,and the endometrial thickness,shape,spiral uterine artery blood flow parameters(pulse index [PI],resistance index [RI],peak systolic velocity/end diastolic peak velocity [S/D]),pregnancy rate and spontaneous abortion rate were counted among the three groups.Results The pregnancy rates in group B and group C were higher than those in group A,the differenceswere statistically significant(P＜0.05).There was no significant difference in the pregnancy rate between group B and group C (P＞0.05).There was no significant difference in spontaneous abortion rate among the three groups (P＞0.05).The endometrial thickness in group B and group C was higher than that in group A,with statistically significant differences(P＜0.05).There was no statistically significant difference in endometrial thickness between group B and group C (P＞0.05).The proportion of endometrium A in group C was higher than that in group A and group B,with statistically significant differences(P＜0.05).There was no statistically significant difference in the proportion of endometrium A between group A and group B (P＞0.05).The PIof group B and group C was lower than that of group A,with statistically significant differences(P＜0.05).There was no statistically significant difference in PIbetween group B and group C(P＞0.05).The RIand S/D in group B and group C were lower than those in group A,and those in group C were lower than those in group B,with statistically significant differences(P＜0.05).Conclusion The combination of Chinese medicine and acupuncture can definitely improve the endometrial thickness and uterine artery blood flow parameters,and can increase the clinical pregnancy rate of patientswith occult POIwith infertility.

Key words： Occult primary ovarian insufficiency Pregnancy rate Uterine artery blood flow parameters Endometrial receptivity Baliao acupoint Oral administration of Chinesemedicine

引用本文:

向曦; 黄晓桃; 葛蔓; 高静. 自拟补肾活血助孕汤配合温针灸八髎穴治疗隐匿性原发性卵巢功能不全合并不孕症的临床效果[J]. 中国当代医药, 2020, 27(17): 162-166.
XIANG Xi; HUANG Xiao-tao; GE Man; GAO Jing. Clinical effect of self-made Bushen Huoxue Zhuyun Decoction combined with warm acupuncture at Baliao acupoint in the treatment of occult primary ovarian insufficiency with infertility. 中国当代医药, 2020, 27(17): 162-166.

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