本文選題：穴位貼敷法 + 先兆流產(chǎn)�。� 參考：《浙江中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：觀察安胎Ⅰ號穴位貼敷改善腎虛型先兆流產(chǎn)患者癥狀的臨床效果,分析改善癥狀的相關(guān)因素,為腎虛型先兆流產(chǎn)患者選擇安全有效地改善癥狀的中醫(yī)護(hù)理方法提供科學(xué)依據(jù)。方法于2015年5月-12月,便利選取在杭州市中醫(yī)院診療的腎虛型先兆流產(chǎn)患者78例,隨機(jī)分為干預(yù)組和對照組,各39例。對照組接受由同一中醫(yī)師制定的中西醫(yī)結(jié)合治療方案及常規(guī)健康教育；干預(yù)組在對照組基礎(chǔ)上接受安胎Ⅰ號穴位貼敷,每日1次,每次6-8小時(shí),7次為1療程,共2個(gè)療程。評估并記錄兩組入組前、入組7天、入組14天的中醫(yī)證候積分(主/次癥)、人絨毛膜促性腺激素(HCG)、孕酮(P)、雌二醇(E2)、焦慮自評量表(SAS)；受試對象每天采用觀察法和視覺模擬量表(VAS)對陰道出血、腰酸及腹痛進(jìn)行自我評估,計(jì)算穴位貼敷后陰道出血、腰酸、腹痛緩解時(shí)間；跟蹤隨訪至妊娠12周,根據(jù)胎兒頸項(xiàng)透明層(NT)比較兩組繼續(xù)妊娠率。結(jié)果：完成全部資料收集的受試對象73例,其中對照組36例,干預(yù)組37例,兩組繼續(xù)妊娠率比較,無統(tǒng)計(jì)學(xué)差異(P0.05)。1.入組前、入組7天、入組14天,三次重復(fù)測量的結(jié)果顯示,兩組次癥中醫(yī)證候積分組間差異無統(tǒng)計(jì)學(xué)意義(P0.05),但與時(shí)間存在交互作用(P0.05);兩組主癥中醫(yī)證候積分組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05),隨入組時(shí)間的延續(xù)呈下降趨勢(P0.05),且干預(yù)組下降程度大于對照組。2.兩組陰道出血持續(xù)率比較,無統(tǒng)計(jì)學(xué)差異(P0.05),對照組、干預(yù)組中位持續(xù)時(shí)間分別為4天、6天；兩組腰酸、腹痛持續(xù)率比較,均有統(tǒng)計(jì)學(xué)差異伊0.05),對照組、干預(yù)組腰酸中位持續(xù)時(shí)間分別為12天、3天,腹痛中位持續(xù)時(shí)間分別為11天、6天。3.Cox比例風(fēng)險(xiǎn)回歸模型顯示,穴位貼敷、宮腔鏡、入組前腰酸持續(xù)時(shí)間、孕周為縮短腎虛型先兆流產(chǎn)患者腰酸、腹痛癥狀持續(xù)時(shí)間的重要獨(dú)立影響因素。其中穴位貼敷(RR=6.44,95%Cl:3.07～13.59)、宮腔鏡(RR=0.39,95%CI:0.39～0.82)、入組前腰酸持續(xù)時(shí)間(RR=0.92,95%CI:0.85～0.99)是影響腰酸改善的因素(P0.05);穴位貼敷(RR=3.44,95%CI:1.84～6.45)、孕周(RR=0.61,95%CI:0.41～0.92)是影響腹痛改善的因素(P0.05)。4.入組14天,兩組孕酮水平均較入組前升高,有統(tǒng)計(jì)學(xué)差異伊0.05);組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。5.入組14天,兩組SAS評分均較入組前降低,有統(tǒng)計(jì)學(xué)差異(P0.05);組間比較無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.安胎Ⅰ號穴位貼敷可改善腎虛型先兆流產(chǎn)患者主癥中醫(yī)證候,是腰酸、腹痛改善的保護(hù)因素；2.臨床上應(yīng)加強(qiáng)對有宮腔鏡史者、入組前腰酸持續(xù)時(shí)間長者、孕周大于6周者進(jìn)行腰酸、腹痛改善緩慢的健康宣教；3.在貼敷期間,安胎Ⅰ號穴位貼敷對HCG、 E2、P、SAS評分無影響,改善癥狀安全可靠,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to observe the clinical effect of Acupoint Application No. 1 of Anfen on improving the symptoms of threatened abortion patients with kidney deficiency type, and to analyze the related factors of improving symptoms.To provide scientific basis for the choice of TCM nursing method to improve symptoms safely and effectively in patients with threatened abortion of kidney deficiency type.Methods from May to December, 2015, 78 patients with renal deficiency threatened abortion who were diagnosed and treated in Hangzhou traditional Chinese Medicine Hospital were randomly divided into intervention group and control group, each with 39 cases.The control group received the treatment plan and routine health education made by the same traditional Chinese medicine doctor, and the intervention group received the ANFI acupoint application on the basis of the control group, once a day, 6-8 hours and 7 times each time as a course of treatment, a total of two courses of treatment.The two groups were evaluated and recorded 7 days before they entered the group.The TCM syndromes scores (main / secondary symptoms, HCG, progesterone, estradiol estradiol E2P, self rating anxiety scale (SAS)) of 14 days in the study group were used to treat vagina hemorrhage, and the subjects were treated by observing method and visual analog scale (VASS) every day.Lumbar acid and abdominal pain were self-evaluated to calculate the time of vaginal bleeding, lumber acid and abdominal pain relief after acupoint application, followed up to 12 weeks of pregnancy, and compared the rate of continuous pregnancy between the two groups according to the transparent layer of fetal neck (NTS).Results: there were 73 subjects with complete data collection, including 36 cases in control group and 37 cases in intervention group. There was no significant difference in the rate of continuous pregnancy between the two groups (P 0.05).Before joining the group, 7 days, 14 days into the group, the results of three repeated measurements showed that,There was no significant difference in TCM syndromes integral between the two groups (P 0.05), but there was interaction with time (P 0.05), and the difference between the two groups had statistical significance (P 0.05), which showed a decreasing trend with the duration of entering the group (P 0.05) and dry.The degree of decrease in pretreated group was greater than that in control group.There was no significant difference in the duration of vaginal bleeding between the two groups (P 0.05), while the median duration in the control group was 4 days or 6 days, while the rates of lumbar acid and abdominal pain in the two groups were significantly higher than those in the control group.The median duration of lumbar acid in the intervention group was 12 days / 3 days, and the median duration of abdominal pain was 11 days and 6 days respectively. 3. Cox proportional risk regression model showed that acupoint application, hysteroscopy and anterior lumbar acid duration were observed in the intervention group.Gestational week is an important independent factor for shortening lumbar acid and duration of abdominal pain symptoms in patients with threatened abortion of kidney deficiency type.The level of progesterone in the two groups was higher than that before the entry, and there was no statistical difference between the two groups (P 0.05. 5).On the 14th day, the SAS scores of the two groups were significantly lower than those of the control group (P 0.05), but there was no significant difference between the two groups (P 0.05).Conclusion 1.Antii No. 1 acupoint application can improve the main symptoms of kidney deficiency type threatened abortion patients TCM syndrome, is the lumbar acid, abdominal pain improvement of the protective factors 2.The patients with hysteroscopic history, the patients who had a history of hysteroscopy, the patients who had a history of hysteroscopy, the patients who had a history of hysteroscopy, the patients who had a lasting time of anterior lumbar acid, and those who were pregnant more than 6 weeks should be given lumbar acid.During the application period, the application of Acupoint Antii No. 1 had no effect on the scores of HCG, E2P and SAS, and it was safe and reliable to improve the symptoms, which was worthy of clinical popularization and application.
【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R248.3

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