一贯煎在妇科临床上的应用

目的：探讨一贯煎在妇科临床上的应用。方法：辨证分析妇科不同证型,一贯煎各方适量加减进行治疗。结果：对于不同证型的妇科疾病,应用一贯煎治疗,效果较好。结论：一贯煎治疗妇科疾病疗效较好。     

Documentation of Sexual and Menstrual Histories for Adolescent Patients in the Inpatient Setting

Study ObjectiveIn this study, we aimed to determine the frequency of menstrual history and sexual history documentation in the inpatient setting.Design, Setting, and ParticipantsA retrospective chart review was conducted for 307 female patients ages 11-18 years admitted from the emergency department at a single institution within a 7-month period. These charts were reviewed for documentation of menstrual and sexual history.Interventions and Main Outcome MeasuresRates of menstrual and sexual history documentation were compared according to patient age, chief complaint, admitting specialty, and medical complexity.ResultsSexual history documentation was noted in 158 (45.9%) of the 344 reviewed charts. Sexual history documentation rates were higher for patients with mental health symptoms (62.9%; 61 of 98 charts; P = .02) and lower for patients admitted to surgical services (30.6%; 19 of 62 charts; P = .04). At least 1 aspect of menses was documented in 113 (32.8%) of the 344 reviewed charts. Last menstrual period was the most commonly documented aspect of menstrual history, appearing in 100 (29.1%) of the 344 reviewed charts. Menarche (4.4%; 15/344), menses frequency (7.0%; 24/344), menses duration (2.6%; 9/344), flow quantity (4.9%; 17/344), and dysmenorrhea (4.4%; 15/344) were rarely documented, regardless of chief complaint or admitting service. Menstrual history documentation rates were significantly higher for patients requiring a gynecology consultation (73.3%; 11 of 15 charts; P < .01).ConclusionMenstrual and sexual history documentation rates for adolescent patients requiring inpatient admission were low, with fewer than half of patients having a documented menstrual or sexual history.     

多囊卵巢综合征患者心理健康状况研究进展

多囊卵巢综合征（PCOS）是育龄妇女最常见的内分泌疾病,占无排卵性不孕的70%～80%。PCOS是一种具有高度异质性的内分泌及代谢性疾病,临床表现呈现多样性,至今病因未明,心理因素对于PCOS的发生和发展起着重要的作用。国内外多项研究表明,PCOS患者较正常人存在明显的抑郁、焦虑等心理障碍,同时这些心理问题又能加重内分泌功能失调,进一步导致PCOS病情的发展。因此,临床上制定有关治疗、预防PCOS的策略及具体实施方案时,应重视心理社会因素的作用,以利对患者综合全面地治疗,提高其生活质量。     

黄体期使用米非司酮配伍米索前列醇避孕对月经影响的临床研究

目的:探讨妇女在无保护性生活超过120h,或多次无保护性生活后在黄体期使用米非司酮配伍米索前列醇避孕对月经的影响。方法:观察对象在黄体期一次性服用米非司酮100mg并在36～48h后服用米索前列醇400μg,服药后随访2个月经周期。结果:在成功避孕的289例(98.6%)中,服药前月经周期29.36±2.14d,服药当月月经周期26.15±3.68d,差异有统计学意义(t=15.498,P<0.05);服药前经期5.42±1.02d,服药后当月经期5.61±1.09d,差异有统计学意义(t=-4.143,P(0.05);服药后当月经量与自身既往经量比较,无变化215例(74.4%),减少59例(20.4%),增多15例(5.2%)。服药后次月月经周期为29.65±2.82d,与服药前相比差异无统计学意义(t=-1.922,P>0.05);经期5.46±1.03d,与服药前比较差异无统计学意义(t=-1.609,P>0.05);经量无变化273例(94.5%),减少10例(3.5%),增多6例(2.1%)。服药距预计月经时间越长月经提前的时间就越长(F=3.445,P<0.05)。结论:妇女黄体期使用米非司酮配伍米索前列醇避孕有效率高,可使服药当月月经周期缩短、经期延长,且服药距预计月经时间越长对月经影响越大,但对以后月经无影响。     

Epidemiological and clinical aspects of migraine in users of combined oral contraceptives

Background

Migraine was assessed in users of combined oral contraceptives (COCs).

Study Design

This study had a cross-sectional design. Women with headaches were evaluated according to International Headache Society criteria and subsequently allocated to a “migraine” or “non-migraine” group.

Results

Migraine was detected in 80/480 women (16.6%), while other types of headache not classified as migraine were observed in 400 women (83.4%). Following COC use, headaches worsened in 32.5% and 19.3% [odds ratio (OR)=3.02; 95% confidence interval (CI)=1.68-5.4] and improved in 30% and 13.8% (OR=3.9; 95% CI=2.12-7.18) of the “migraine” and “non-migraine” groups, respectively. In the migraine group only, headache episodes occurred predominantly during or around the hormone-free interval (OR=2.05; 95% CI=1.26-3.35). The combination of ethinylestradiol (EE) and drospirenone (DRS) was significantly associated with an improvement in the frequency and/or intensity of migraine-type headaches, compared with other types of COCs.

Conclusions

The prevalence of migraine in COC users appears similar to that found in the general population. Migraines, but not other types of headache, were significantly affected by COCs. The EE/DRS combination was associated with a greater likelihood of improvement in migraine compared with other types of COCs.     

Factors Associated with Increased Pain in Primary Dysmenorrhea: Analysis Using a Multivariate Ordered Logistic Regression Model

Study Objective

In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain.

1 056例皮下埋植避孕剂取出原因分析

目的：探讨皮下埋植避孕剂取出原因与取出年龄和放置时间的关系。方法：对1994年1月—2014年12月在本所门诊取出皮下埋植避孕剂的1 056例育龄妇女进行取出原因分析,比较不同取出年龄段及不同放置时间的因症取出原因的构成比。结果：1 056例皮下埋植避孕剂取出人群中,539例期满取出,395例因月经异常取出,97例因除月经外其他不适取出,23例因计划妊娠或改用其他避孕方法取出,2例在有效期内避孕失败取出。皮下埋植避孕剂取出原因构成比在不同取出年龄组中差异有统计学意义（P＜0.05）,在不同放置时间组中差异无统计学意义（P＞0.05）;其中不同取出年龄和放置时间组中,月经异常和头痛、痤疮等其他症状的构成比差异均有统计学意义（P＜0.05）,计划妊娠或改用其他避孕方法的构成比差异无统计学意义（P＞0.05）。结论：皮下埋植避孕剂是持久、高效、简便的避孕方法,月经异常和头痛、痤疮等症状是不同年龄段和放置时间皮下埋植避孕剂取出的主要原因。     

卵巢恶性生殖细胞肿瘤术后化疗对卵巢功能的影响研究

目的：观察并探讨卵巢恶性生殖细胞肿瘤（malignant ovarian germ cell tumors,MOGCT）患者术后化疗对卵巢功能的影响。方法：入选本院肿瘤科2009年7月至2012年6月间收治的MOGCT行术后辅助化疗患者34例为研究对象（化疗组）,选取同期收治的年龄相近、有生育要求且经手术切除后未经化疗的31例卵巢上皮交界性肿瘤患者作为对照组,化疗组术后进行4个周期顺铂（DDP）＋依托泊苷（VP-16）＋博来霉素（BLM）（PEB）方案或顺铂（DDP）＋紫杉醇（TAX）（PT）方案化疗,术后随访12个月,对比两组血清性激素水平与月经变化情况。结果：①术后6个月,化疗组血清黄体生成素（LH）、促卵泡生成素（FSH）水平明显高于对照组（P＜0.05）,而雌二醇（E2）水平则明显低于对照组（P＜0.05）;术后12个月化疗组LH、FSH水平较之6个月时显著下降,E2水平显著上升,两组LH、FSH、E2差异无统计学意义（P＞0.05）。②化疗组化疗期间停经17例（50％）、月经量减少10例（29.4％）,截至随访结束,15例（88.2％）停经患者月经复潮,月经量较术前减少;对照组31例患者仅有4例（12.9％）出现月经减少,两组术后月经异常率差异具有统计学意义（χ2＝28.752,P＝0.000）。③化疗组与对照组近期有生育计划且成功妊娠的比例分别为44.0％（11/25）、62.5％（15/24）,两组差异无统计学意义（χ2＝1.683,P＝0.195）。结论：MOGCT术后化疗近期可引发性激素水平变化与月经异常,主要表现为血清促性腺激素水平升高、雌激素水平降低、停经,月经异常具有可逆性,复潮后月经量减少。     

桃红四物汤加减治疗黄褐斑伴月经不调60例临床观察

目的：分析桃红四物汤加减治疗黄褐斑伴月经不调的临床效果。方法：选择2011年9月-2013年9月在我院接受治疗的黄褐斑伴月经不调患者60例,随机分为对照组、观察组,每组30例。对照组进行常规治疗,观察组在对照组治疗基础上,应用桃红四物汤进行治疗,分析两组的治疗效果。结果：对照组总有效率为80.0%,观察组总有效率为96.7%,观察组明显的大于对照组,差异显著。黄褐斑的面积、月经不调总评分明显变小,观察组明显低于对照组,P〈0.05,差异具有统计学意义。结论：基于常规治疗,应用桃红四物汤加减治疗,对黄褐斑伴月经不调的治疗效果较为明显,黄褐斑的面积明显的变小,月经不调明显好转,值得临床推广。     

罗颂平教授治疗不孕症经验介绍

罗颂平教授在治疗复发性流产、不孕、月经不调等疾病方面经验丰富,特别在治疗复发性流产及不孕症上更是有独到的经验,笔者在跟诊期间获益良多。本文分别从治病求因,种子首重调经,指导调摄等方面介绍罗颂平教授治疗不孕症的经验。