摘要
目的探讨自拟中药汤剂对妊娠期高血压患者妊娠结局的影响.方法选择2016年10月至2018年10月贵州省人民医院重症医学科收治的妊娠期高血压患者124例.以采用西医常规方法治疗的62例患者为西医常规治疗组;以在西药常规治疗基础上加用自拟中药的62例患者为自拟中药治疗组.西医常规治疗组给予硫酸镁联合尼卡地平;自拟中药治疗组在西药常规治疗基础上加用自拟中药汤剂(组成:钩藤、生牡蛎20g,天麻、杜仲、丹参、茯苓、熟地黄各15g,川芎、桑寄生、黄芩、麦冬各10g;头痛头晕严重者加龟甲、龙胆草各15g,知母10g;水肿严重者加桂枝、天仙藤各15g,黄芪、生姜皮各10g),水煎服,早晚分服,每日1剂,1周为1个疗程,两组均持续用药4周后评价临床疗效.观察两组治疗前后血压、凝血指标、胎盘床动脉血流动力学指标、妊娠结局指标的变化;并记录治疗后临床疗效及不良反应发生情况.结果两组治疗后收缩压(SBP)、舒张压(DBP)、纤维蛋白原(Fib)、胎盘床动脉搏动指数(PI)、收缩期末血流速度与舒张期末血流速度比值(S/D)、阻力指数(RI)均较治疗前降低,凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均较治疗前明显延长,时间平均流速(TAV)较治疗前增加;且自拟中药治疗组治疗后SBP、DBP、Fib、PI、S/D、RI均明显低于西医常规治疗组〔SBP(mmHg,1mmHg=0.133kPa):114.26±17.07比132.72±17.64,DBP(mmHg):82.98±6.24比90.09±6.48,Fib(g/L):3.21±0.45比3.64±0.31,PI:0.59±0.14比0.75±0.15,S/D:1.70±0.21比1.93±0.25,RI:0.43±0.08比0.54±0.12,均P<0.05〕,PT、APTT、TAV均明显高于西医常规治疗组〔PT(s):12.26±0.57比11.72±0.44,APTT(s):27.11±1.34比25.69±1.48,TAV(cm/s):15.64±2.88比12.49±2.76,均P<0.05〕.自拟中药治疗组剖宫产率及产后出血、胎心异常、新生儿窒息发生率均明显低于西医常规治疗组〔剖宫产率:9.84%(6/61)比27.78%(15/54),产后出血率:1.64%(1/61)比14.81%(8/54),胎心异常率:3.28%(2/61)比16.67%(9/54),新生儿窒息发生率:1.64%(1/61)比12.96%(7/54),均P<0.05〕.自拟中药治疗组总有效率明显高于西医常规治疗组〔98.39%(61/62)比87.10%(54/62),P<0.05〕;但不良反应发生率与西医常规治疗组比较差异无统计学意义〔16.39%(10/61)比16.67%(9/54),P>0.05〕.结论自拟中药汤剂可通过改善妊娠期高血压患者的高凝状态、胎盘血流动力学,从而改善母婴结局,降压效果显著且安全性好.
Objective To investigate the effect of self-made traditional Chinese medicine(TCM)decoction on pregnancy outcome in patients with hypertensive disorder complicating pregnancy.Methods A total of 124 pregnant hypertensive patients admitted to the Department of Critical Care of Guizhou Provincial People's Hospital from October 2016 to October 2018 were enrolled.The 62 patients who were treated with western medicine conventional method;62 patients who were treated with self-made TCM decoction on the basis of western medicine conventional method.The western medicine conventional treatment group was given magnesium sulfate combined with nicardipine;the self-made TCM treatment group was supplemented with TCM decoction on the basis of conventional western medicine treatment(composition:uncaria,raw oyster 20 g,gastrodia elata,eucommia,salvia miltiorrhiza,medlar rehmannia glutinosa each 15 g,rhizoma,mulberry parasitic,astragalus,ophiopogonis each 10 g.Severe headache and dizziness plus tortoise shell,gentian grass 15 g,anemarrhenae 10 g;severe edema plus cassia twig,aristolochiae 15 g,astragali,ginger skin 10 g),be decocted in water for oral dose,morning and evening oral,one dose a day,1 week for a course of treatment,the two groups were continued for 4 weeks after the evaluation of clinical efficacy.The changes of blood pressure and blood coagulation parameters,placental bed arterial hemodynamics,pregnancy outcome index were observed before and after treatment;antihypertensive effects and adverse reactions after treatment were recorded.Results After treatment,the systolic blood pressure(SBP),diastolic blood pressure(DBP),Fibrinogen(Fib),placental bed arterial pulsation index(PI),end-systolic blood flow velocity and end-diastolic blood flow velocity ratio(S/D)and resistance index(RI)in both groups were lower than those before treatment,the prothrombin time(PT)and activated partial thromboplastin time(APTT)were significantly longer than before treatment,and the time-averaged flow rate(TAV)increased than that before treatment;SBP,DBP,Fib,PI,S/D and RI were significantly lower in self-made TCM treatment group than those in western medicine conventional treatment group[SBP(mmHg,1 mmHg=0.133 kPa):114.26±17.07 vs.132.72±17.64,DBP(mmHg):82.98±6.24 vs.90.09±6.48,Fib(g/L):3.21±0.45 vs.3.64±0.31,PI:0.59±0.14 vs.0.75±0.15,S/D:1.70±0.21 vs.1.93±0.25,RI:0.43±0.08 vs.0.54±0.12,all P<0.05],PT,APTT,TAV in self-made TCM treatment group were significantly higher than western medicine conventional treatment group[PT(s):12.26±0.57 vs.11.72±0.44,APTT(s):27.11±1.34 vs.25.69±1.48,TAV(cm/s):15.64±2.88 vs.12.49±2.76,all P<0.05].The rate of cesarean section,postpartum hemorrhage,fetal heart abnormality and neonatal asphyxia in self-made TCM treatment group were significantly lower than those in western medicine conventional treatment group[cesarean section rate:9.84%(6/61)vs.27.78%(15/54),postpartum hemorrhage rate:1.64%(1/61)to 14.81%(8/54),fetal heart abnormal rate:3.28%(2/61)vs.16.67%(9/54),the incidence of neonatal asphyxia:1.64%(1/61)vs.12.96%(7/54),all P<0.05].The total effective rate of the self-made TCM treatment group was significantly higher than that of western medicine conventional treatment group[98.39%(61/62)vs.87.10%(54/62),P<0.05].However,there was no significant difference in the incidence of adverse reactions between the self-made TCM treatment group and western medicine conventional treatment group[16.39%(10/61)vs.16.67%(9/54),P>0.05].Conclusion Self-made TCM decoction can improve the maternal and infant outcomes by improving the hypercoagulable state and placental hemodynamics in hypertensive patients with hyperthyroidism,the antihypertensive effect is remarkable and the safety is good.
作者
吴婧
叶八宁
施贤清
王宇辉
Wu Jing;Ye Baning;Shi Xianqing;Wang Yuhui(Department of Critical Care,Guizhou Provincial People's Hospital,Guiyang 550002,Guizhou,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第4期436-440,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
贵州省人民医院国家自然科学基金培育基金(黔科合平台人才〔2018〕5764-09)
贵州省科技合作计划(黔科合LH字〔2015〕7172号).
关键词
妊娠期高血压
自拟中药汤剂
硫酸镁
尼卡地平
Hypertensive disorder complicating pregnancy
Self-made traditional Chinese medicine decoction
Magnesium sulfate
Nicardipine
