左炔諾孕酮宮內節(jié)育系統(tǒng)治療合并內科疾病月經過多的臨床分析
發(fā)布時間：2019-06-05 21:53
【摘要】：背景與目的月經過多是育齡期女性最常見的一種臨床表現(xiàn),也是嚴重困擾育齡期女性的健康問題。某些內科疾病本身或治療可引起月經過多,而且某些合并內科疾病月經過多患者有激素治療禁忌或較高的手術治療風險,因此其治療方案選擇受到限制。現(xiàn)臨床上嘗試應用左炔諾孕酮宮內節(jié)育系統(tǒng)治療合并內科疾病月經過多患者,本研究通過回顧性分析,評估左炔諾孕酮宮內節(jié)育系統(tǒng)(LNG-IUS)治療合并內科疾病的月經過多患者的有效性及探討其臨床應用價值。資料與方法收集整理2011年1月-2016年1月在鄭州大學第一附屬醫(yī)院就診的月經過多使用LNG-IUS治療的住院患者臨床資料,通過排除標準,納入80例符合條件患者,其中合并內科疾病的月經過多患者36例,無合并癥患者44例;合并內科疾病分別是:腎功能不全(6例)、血液系統(tǒng)疾病(5例)、系統(tǒng)性紅斑狼瘡(3例)、肝功能不全(5例)、乳癌術后(5例)、心臟病瓣膜置換術后(1例)、糖尿病(3例)、甲狀腺疾病(8例)。通過門診復查或電話詢問放置LNG-IUS后3個月、6個月的患者月經量變化、血紅蛋白水平、子宮內膜厚度、不良反應、滿意度、妊娠情況、自身內科疾病進展等指標。結果1.合并內科疾病組患者入院時基線數據如下:年齡是(39.0±8.4)歲,體質量指數是(23.8±3.0)kg/m2,孕次是(2.92±1.42)次,產次是(1.56±0.94)次,血紅蛋白水平是(85.2±13.0)g/L,子宮內膜厚度是(11.2±2.4)mm;無合并癥組患者入院時基線數據如下:年齡是(42.3±5.9)歲,體質量指數是(23.4±2.3)kg/m2,孕次是(2.93±1.28)次,產次是(1.70±0.77)次,血紅蛋白水平是(86.1±14.9)g/L,子宮內膜厚度是(11.0±2.3)mm;2組入院時年齡、體質量指數、孕次、產次、血紅蛋白水平和子宮內膜厚度比較差異無統(tǒng)計學意義(P0.01)。2.合并內科疾病組放置LNG-IUS 3個月時,2例脫環(huán),4例月經量多不改善,1例月經量多不改善因脫環(huán)引起,放置LNG-IUS 6個月時,1例脫環(huán),2例月經量不改善;無內并癥組放置LNG-IUS 3個月,2例脫環(huán),2例月經量不改善,放置LNG-IUS 6個月,2例脫環(huán),1例月經量不改善;放置LNG-IUS后3個月、6個月合并內科疾病組有效率分別為:86.1%和91.2%,無合并癥組有效率分別為90.9%和92.2%,2組療效比較差異無統(tǒng)計學意義(P0.05)。3.合并內科疾病組放置LNG-IUS前子宮內膜厚度:(11.2±2.4)mm,放置LNG-IUS后3個月、6個月分別是:(8.4±1.7)mm、(6.1±2.1)mm;無合并癥組放置LNG-IUS前子宮內膜厚度:(11.0±2.3)mm;放置LNG-IUS 3個月、6個月分別是:(8.0±1.9)mm、(5.8±1.4)mm,2組放置LNG-IUS 3個月、6個月與放置LNG-IUS前相比,子宮內膜厚度差異比較均具有統(tǒng)計學意義(P0.05),但放置LNG-IUS 3個月、6個月時2組子宮內膜厚度比較差異無統(tǒng)計學意義(P0.05)。4.合并內科疾病組放置LNG-IUS前血紅蛋白水平:(85.2±13.0)g/L,放置LNG-IUS 3個月、6個月分別是:(91.5±10.9)g/L、(101.5±7.9)g/L;無合并癥組放置LNG-IUS前血紅蛋白水平:(86.1±14.9)g/L,放置LNG-IUS 3個月、6個月分別是:(93.6±12.4)g/L、(102.3±9.0)g/L;2組放置LNG-IUS 3個月、6個月與放置LNG-IUS前相比,血紅蛋白差異比較均具有統(tǒng)計學意義(P0.05),但放置LNG-IUS 3個月、6個月時2組血紅蛋白水平比較差異無統(tǒng)計學意義(P0.05)。5.放置LNG-IUS后2組主要的不良反應是出現(xiàn)陰道點滴和不規(guī)則出血,合并內科疾病組放置LNG-IUS 6個月滿意度是83.3%(30/36),無合并癥組放置LNG-IUS 6個月滿意度是79.5%(35/44)。6.合并內科疾病組所有患者放置LNG-IUS后均繼續(xù)治療原發(fā)內科疾病,在6個月隨訪期間無一原發(fā)內科疾病進展。7.2組所有患者放置LNG-IUS后的6個月隨訪期間無一例患者出現(xiàn)帶器妊娠。結論1.左炔諾孕酮宮內節(jié)育系統(tǒng)能有效治療月經過多。2.左炔諾孕酮宮內節(jié)育系統(tǒng)對治療合并內科疾病月經過多也同樣有效,且療效與無合并癥月經過多相當;其療效顯著、高效避孕、對原發(fā)內科疾病影響較小,患者滿意度高,有望廣泛用于合并內科疾病月經過多患者治療。
[Abstract]:Background and objective are the most common clinical manifestations of women in the age of childbearing age, and are also a serious problem for women in the age of childbearing age. The choice of treatment options is limited by the fact that some of the internal medical conditions themselves or the treatment can cause excessive morbidity and that some of the patients with internal medical conditions have a hormone-treated contraindication or a higher risk of surgical treatment. The clinical application of levonorgestrel intrauterine birth control system in the treatment of large excess of patients with internal medical diseases is currently being tried, and this study is analyzed retrospectively. To evaluate the effectiveness of levonorgestrel in the treatment of combined internal medical diseases and to explore the value of its clinical application. Materials and Methods: From January 2011 to January 2016, the clinical data of the patients with excessive use of LNG-IUS in the first affiliated hospital of Zhengzhou University were collected and the clinical data of 80 eligible patients were included in the exclusion criteria, of which 36 patients with hypermenorrhea with internal medical condition were included. 44 cases with no co-morbidities; the combined internal medicine diseases were: renal insufficiency (6 cases), blood system diseases (5 cases), systemic lupus erythematosus (3 cases), hepatic insufficiency (5 cases), breast cancer operation (5 cases), and heart valve replacement (1 case). Diabetes (3 cases), thyroid disease (8 cases). The changes of menstrual flow, hemoglobin level, endometrial thickness, adverse reaction, degree of satisfaction, pregnancy and the progress of internal medical conditions were measured by out-patient review or telephone interrogation for 3 months after the placement of the LNG-IUS. Results 1. The baseline data were as follows: age (39.0-8.4), body mass index (23.8-3.0) kg/ m2, pregnancy (2.92-1.42) times, birth time (1.56-0.94) times, hemoglobin level (85.2-13.0) g/ L, and endometrial thickness (11.2-2.4) mm; The baseline data for patients with no co-morbidities were as follows: age (42.3-5.9) years, body mass index (23.4-2.3) kg/ m2, gestational time (2.93-1.28) times, birth time (1.70-0.77) times, hemoglobin level (86.1-14.9) g/ L, and endometrial thickness (11.0-2.3) mm; There was no significant difference in age, body mass index, gestational age, birth time, hemoglobin level and endometrial thickness in group 2 (P0.01). In the combined internal medical condition group, when the LNG-IUS was placed for 3 months,2 cases of dering and 4 cases of menoxenia were not improved, one case was not improved due to the removal of the ring, and when the LNG-IUS was placed for 6 months, one case was de-ring, and 2 cases were not improved; in the absence of the internal and the treatment group, the LNG-IUS was placed for 3 months,2 cases were de-ring, and the amount of the 2 cases was not improved. The effective rate was 86.1% and 91.2% in 6 months after the LNG-IUS was placed, and the effective rate was 90.9% and 92.2%, respectively. There was no significant difference between the two groups (P0.05). The thickness of the pre-endometrial thickness of the LNG-IUS was (11.2-2.4) mm in combination with the internal medical condition group,3 months after the placement of the LNG-IUS,6 months were: (8.4-1.7) mm, (6.1-2.1) mm, and no co-morbidities were placed in the pre-endometrial thickness of the LNG-IUS: (11.0-2.3) mm; the LNG-IUS was placed for 3 months and the 6-month period was: (8.0-1.9) mm, (5.8-1.4) mm,2 groups were placed in the LNG-IUS for 3 months and 6 months in comparison with the placement of the LNG-IUS, the difference in the thickness of the endometrium was statistically significant (P0.05), but the difference of the thickness of the endometrium in the two groups was not statistically significant at 6 months (P0.05). The level of hemoglobin-IUS pre-hemoglobin was placed in the combined internal medicine disease group: (85.2-13.0) g/ L, and the LNG-IUS for 3 months and 6 months were: (91.5-10.9) g/ L, (101.5-7.9) g/ L, and no-complication group was placed in the pre-determined hemoglobin level of the LNG-IUS: (86.1-14.9) g/ L, and the LNG-IUS for 3 months and 6 months were respectively: (93.6-12.4) g/ L, (102.3-9.0) g/ L, and the difference of hemoglobin in group 2 was statistically significant (P0.05). The main adverse reactions in the 2 groups after the LNG-IUS were placed were vaginal drop and irregular hemorrhage. The satisfactory degree of satisfaction was 83.3% (30/36) in the combined internal medical condition group and 79.5% (35/44). All patients in the combined internal medical disease group continued to treat the primary internal medical condition following the placement of the LNG-IUS and none of the primary internal medical conditions progressed during the 6-month follow-up. There was no one patient with a belt pregnancy during the 6-month follow-up period following the placement of the LNG-IUS in all patients in the group. Conclusion 1. The levonorgestrel intrauterine system is effective in treating hypermenorrhea. The levonorgestrel intrauterine birth control system is also effective in the treatment of the hypermenorrhea of the combined internal medicine, and the curative effect is equivalent to that of the non-co-morbidities; and the levonorgestrel intrauterine device has the advantages of remarkable curative effect, high-efficiency contraception, small influence on the primary internal medicine disease and high patient satisfaction, Is expected to be widely used in the treatment of patients with excessive internal medical diseases.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.51
，
本文編號：2493850
[Abstract]:Background and objective are the most common clinical manifestations of women in the age of childbearing age, and are also a serious problem for women in the age of childbearing age. The choice of treatment options is limited by the fact that some of the internal medical conditions themselves or the treatment can cause excessive morbidity and that some of the patients with internal medical conditions have a hormone-treated contraindication or a higher risk of surgical treatment. The clinical application of levonorgestrel intrauterine birth control system in the treatment of large excess of patients with internal medical diseases is currently being tried, and this study is analyzed retrospectively. To evaluate the effectiveness of levonorgestrel in the treatment of combined internal medical diseases and to explore the value of its clinical application. Materials and Methods: From January 2011 to January 2016, the clinical data of the patients with excessive use of LNG-IUS in the first affiliated hospital of Zhengzhou University were collected and the clinical data of 80 eligible patients were included in the exclusion criteria, of which 36 patients with hypermenorrhea with internal medical condition were included. 44 cases with no co-morbidities; the combined internal medicine diseases were: renal insufficiency (6 cases), blood system diseases (5 cases), systemic lupus erythematosus (3 cases), hepatic insufficiency (5 cases), breast cancer operation (5 cases), and heart valve replacement (1 case). Diabetes (3 cases), thyroid disease (8 cases). The changes of menstrual flow, hemoglobin level, endometrial thickness, adverse reaction, degree of satisfaction, pregnancy and the progress of internal medical conditions were measured by out-patient review or telephone interrogation for 3 months after the placement of the LNG-IUS. Results 1. The baseline data were as follows: age (39.0-8.4), body mass index (23.8-3.0) kg/ m2, pregnancy (2.92-1.42) times, birth time (1.56-0.94) times, hemoglobin level (85.2-13.0) g/ L, and endometrial thickness (11.2-2.4) mm; The baseline data for patients with no co-morbidities were as follows: age (42.3-5.9) years, body mass index (23.4-2.3) kg/ m2, gestational time (2.93-1.28) times, birth time (1.70-0.77) times, hemoglobin level (86.1-14.9) g/ L, and endometrial thickness (11.0-2.3) mm; There was no significant difference in age, body mass index, gestational age, birth time, hemoglobin level and endometrial thickness in group 2 (P0.01). In the combined internal medical condition group, when the LNG-IUS was placed for 3 months,2 cases of dering and 4 cases of menoxenia were not improved, one case was not improved due to the removal of the ring, and when the LNG-IUS was placed for 6 months, one case was de-ring, and 2 cases were not improved; in the absence of the internal and the treatment group, the LNG-IUS was placed for 3 months,2 cases were de-ring, and the amount of the 2 cases was not improved. The effective rate was 86.1% and 91.2% in 6 months after the LNG-IUS was placed, and the effective rate was 90.9% and 92.2%, respectively. There was no significant difference between the two groups (P0.05). The thickness of the pre-endometrial thickness of the LNG-IUS was (11.2-2.4) mm in combination with the internal medical condition group,3 months after the placement of the LNG-IUS,6 months were: (8.4-1.7) mm, (6.1-2.1) mm, and no co-morbidities were placed in the pre-endometrial thickness of the LNG-IUS: (11.0-2.3) mm; the LNG-IUS was placed for 3 months and the 6-month period was: (8.0-1.9) mm, (5.8-1.4) mm,2 groups were placed in the LNG-IUS for 3 months and 6 months in comparison with the placement of the LNG-IUS, the difference in the thickness of the endometrium was statistically significant (P0.05), but the difference of the thickness of the endometrium in the two groups was not statistically significant at 6 months (P0.05). The level of hemoglobin-IUS pre-hemoglobin was placed in the combined internal medicine disease group: (85.2-13.0) g/ L, and the LNG-IUS for 3 months and 6 months were: (91.5-10.9) g/ L, (101.5-7.9) g/ L, and no-complication group was placed in the pre-determined hemoglobin level of the LNG-IUS: (86.1-14.9) g/ L, and the LNG-IUS for 3 months and 6 months were respectively: (93.6-12.4) g/ L, (102.3-9.0) g/ L, and the difference of hemoglobin in group 2 was statistically significant (P0.05). The main adverse reactions in the 2 groups after the LNG-IUS were placed were vaginal drop and irregular hemorrhage. The satisfactory degree of satisfaction was 83.3% (30/36) in the combined internal medical condition group and 79.5% (35/44). All patients in the combined internal medical disease group continued to treat the primary internal medical condition following the placement of the LNG-IUS and none of the primary internal medical conditions progressed during the 6-month follow-up. There was no one patient with a belt pregnancy during the 6-month follow-up period following the placement of the LNG-IUS in all patients in the group. Conclusion 1. The levonorgestrel intrauterine system is effective in treating hypermenorrhea. The levonorgestrel intrauterine birth control system is also effective in the treatment of the hypermenorrhea of the combined internal medicine, and the curative effect is equivalent to that of the non-co-morbidities; and the levonorgestrel intrauterine device has the advantages of remarkable curative effect, high-efficiency contraception, small influence on the primary internal medicine disease and high patient satisfaction, Is expected to be widely used in the treatment of patients with excessive internal medical diseases.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.51
，
本文編號：2493850
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