西地那非对鼠子宫平滑肌及微循环作用的实验研究

目的:探讨西地那非对鼠子宫平滑肌和微循环的影响。方法:采用离体、在体实验方法,分别观察西地那非对正常和痉挛离体大鼠子宫平滑肌的影响、对在体小鼠子宫痉挛的影响以及对大鼠子宫系膜微循环的影响。结果:西地那非中、高剂量组明显抑制子宫平滑肌的收缩幅度和频率,且有剂量关系;缩短小鼠扭体潜伏期和扭体次数(P<0.05、P<0.01)。西地那非高剂量组通过扩张微动脉和微静脉,增加毛细血管网点数,加快血流速度,可明显改善子宫微循环。结论:西地那非可明显松弛子宫平滑肌,改善子宫微循环。     

固冲止崩汤联合妈富隆治疗更年期功能性子宫出血临床效果观察

目的观察固冲止崩汤联合妈富隆治疗更年期功能性子宫出血的临床效果。方法选择更年期功能性子宫出血患者80例,随机分为观察组和对照组,每组各40例。对照组采用妈富隆进行治疗,观察组在对照组基础上加用固冲止崩汤进行治疗。观察两组治疗效果,治疗后控制出血时间、月经规律时间,治疗前后血清促卵泡生成素(FSH)、黄体生成素(LH)、孕激素(PROG)及雌二醇(E2)水平,复发率及子宫内膜厚度。结果观察组有效率为95.00%,明显高于对照组的80.00%,差异有统计学意义(χ2=4.114,P<0.05);观察组控制出血时间、月经规律时间与对照组比较明显减少,差异有统计学意义(P<0.05);观察组治疗后与对照组治疗后比较激素水平降低更加明显,差异有统计学意义(P<0.05);观察组复发率为5.0%,与对照组的22.5%比较,明显降低,差异有统计学意义(P<0.05);与对照组治疗后比较,观察组治疗后子宫内膜厚度降低更加明显,差异有统计学意义(P<0.05)。结论固冲止崩汤联合妈富隆治疗更年期功能性子宫出血可以取得良好的临床效果。     

宫缩乏力性产后出血产妇子宫平滑肌自发性收缩功能变化及产后出血关系研究

目的分析宫缩乏力性产后出血产妇子宫平滑肌自发性收缩功能的变化,并探讨子宫平滑肌收缩功能的变化与产后出血的关系。方法随机选取2015年1月-2016年12月佛山市禅城区中心医院收治的宫缩乏力性产后出血剖宫产患者106例为病例组,另选取同期收治的无产后出血剖宫产患者106例为对照组,对患者临床资料进行分析。采用等长张力测定的方法检测患者离体子宫相关区域平滑肌收缩功能及缩宫素诱导下的收缩潜能,检测平滑肌组织中细胞外信号调节激酶(ERK1/2)、p38磷酸化蛋白和CX43蛋白的表达水平,评定各类分子与产后出血间的关系。结果与对照组比较,病例组子宫平滑肌自发性的收缩幅度、频率及活动力均偏低,差异有统计学意义(P0.05),缩宫素诱导下病例组子宫平滑肌收缩幅度、频率、活动力以及收缩潜能均较诱导前有所提高,但均低于对照组,差异有统计学意义(P0.05)。病例组产妇的离体子宫平滑肌组织中pERK1/2、p-P38和CX43蛋白的表达明显低于对照组,且各类分子的表达与宫缩乏力性产后出血的相关系数均为0.4左右。结论宫缩乏力性产后出血会使产妇子宫平滑肌收缩功能及收缩潜能显著降低,子宫平滑肌组织中p-ERK1/2、p-P38和CX43蛋白的表达与产后出血呈正相关。     

月季花提取液对小鼠离体子宫平滑肌收缩性能的影响

目的探讨不同剂量的月季花提取液对小白鼠离体子宫平滑肌收缩性能的影响。方法采用小白鼠离体子宫实验法,观察不同剂量的月季花提取液对小鼠正常子宫以及缩宫素干预下小鼠离体子宫的收缩幅度、收缩张力、收缩曲线下面积和收缩频率的影响。结果与对照组比较,月季花低剂量组离体子宫收缩频率明显降低(P<0.01),月季花中、高剂量组均能明显降低收缩幅度、收缩张力、收缩面积和收缩频率(P<0.05);与缩宫素组比较,除缩宫素+月季花低剂量组对收缩幅度抑制不明显外,各组均能明显降低收缩幅度、收缩张力、收缩面积和收缩频率(P<0.05),而且随着剂量的增大,收缩性能降低越显著。结论月季花提取液明显抑制小鼠正常离体子宫收缩性能和拮抗缩宫素引起的子宫兴奋效应,具有一定的量效关系。     

4-壬基酚、双酚A对幼雌SD大鼠生殖器官的拟雌激素样作用探讨

目的检测4-壬基酚(4-NP)、双酚A(BPA)对幼雌SD大鼠的拟雌激素样作用和内分泌干扰作用。方法以21日龄雌性SD大鼠为实验对象,选取4-NP和BPA为染毒物质,均设高中低剂量,连续喂饲3天,于末次给药后24h处死。以子宫湿重、脏器系数、子宫内膜及平滑肌增生程度和细胞增殖核抗原(PCNA)的蛋白表达作为检测指标,采用单因素方差分析方法进行统计。结果染毒动物实验结果显示,高中剂量的4-NP(200mg/kg和100mg/kg)和BPA(600mg/kg和400mg/kg)能够使染毒动物的子宫湿重及脏器系数明显增加(P<0.01),并且具有一定的剂量-效应关系;4-NP和BPA高、中、低剂量都能够使子宫内膜上皮增高,平滑肌增厚,PCNA蛋白表达增强(P<0.05)。结论动物染毒实验进一步证实了4-NP、BPA作为环境内分泌干扰物的拟雌激素作用及其剂量-效应关系。     

米非司酮配伍米索前列醇终止妊娠后子宫异常出血与术前凝血因子水平关系

目的：探究米非司酮配伍米索前列醇终止妊娠后子宫异常出血与术前凝血因子水平相关性。方法：选取2020年5月-2023年5月本院接诊自愿要求药物流产者88例,术前检测凝血因子,均给予口服米非司酮片+米索前列醇。分析药物流产后子宫异常出血情况并以此分为异常出血组(n=30)和非异常出血组(n=58),对比两组术前凝血因子水平,Spearman相关性分析子宫异常出血与术前凝血因子关系;受试者工作特征(ROC)曲线分析术前凝血因子水平对子宫异常出血的预测价值。结果：88例术后出血子宫异常出血率为34.1%;非异常出血组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均低于异常出血组,纤维蛋白原(FIB)水平高于异常出血组(均P<0.05);Spearman相关性分析,PT、APTT和TT与子宫异常出血存在正相关,FIB与子宫异常出血存在负相关(均P<0.001);PT、APTT、TT和FIB联合诊断药物流产后子宫异常出血的曲线下面积(0.913)高于各单独指标检测(0.716、0.799、0.788、0.815)(均P<0.05)。结论：米非司酮配伍米...     

多囊卵巢综合征并发功能失调性子宫出血的影响因素分析

目的探讨多囊卵巢综合征并发功能失调性子宫出血的影响因素。方法回顾性分析2017年1月-2018年12月在该院就诊的71例多囊卵巢综合征患者的临床资料,根据其是否并发功能失调性子宫出血分为并发组(18例)与非并发组(53例),分析多囊卵巢综合征并发功能失调性子宫出血的影响因素。结果两组患者年龄(30岁)、BMI (24 kg/m2)、婚姻状况(已婚)、性生活史、妊娠史、分娩史、多囊卵巢综合征病程(12个月)、慢性炎症、合并基础疾病比例比较,差异均无统计学意义(均P0.05);并发组患者贫血、子宫内膜厚度(12 mm)、子宫内膜增生、心理状况异常比例高于非并发组,差异均有统计学意义(均P0.05)。多因素Logistic回归分析结果显示,贫血、子宫内膜厚度(12 mm)、子宫内膜增生、心理状况异常为多囊卵巢综合征并发功能失调性子宫出血的影响因素(OR1,P0.05)。结论贫血、子宫内膜厚度(12 mm)、子宫内膜增生、心理状况异常是多囊卵巢综合征并发功能失调性子宫出血的相关影响因素,临床可通过干预上述因素从而降低多囊卵巢综合征并发功能失调性子宫出血风险。     

子宫异常出血患者的宫腔内微生物检测的临床意义分析

目的:研究子宫异常出血患者的宫腔内微生物检测的临床意义。方法:纳入我院收治的109例子宫异常出血患者(2019年4月至2020年4月)为观察组研究对象,纳入同期109例健康育龄女性为对照组,回顾性分析两组临床资料,所有对象均进行宫腔内微生物(厌氧菌、需氧菌、衣原体、支原体、L型细菌)检测,统计临床数据,对比两组宫腔内微生物检出率,采用Pearson相关性分析,讨论子宫异常出血患者的宫腔内检出微生物的相关性。结果:宫腔内微生物总检出率对比观察组比对照组较高(P<0.05);采用Pearson相关性分析,宫腔内微生物总检出率与子宫异常出血严重程度呈正相关(r=0.7218,P<0.05)。结论:子宫异常出血可能与宫腔内存在微生物有一定关系,可通过对宫腔内微生物种类、数量进行检测来探讨子宫异常出血情况。     

柿叶制剂治疗子宫异常出血的药理研究

目的 :观察柿叶制剂治疗子宫异常出血的药理学作用。方法 :测定柿叶制剂对小鼠出、凝血时间的影响和抗炎作用 ,对正常和妊娠大鼠离体子宫及兔在体子宫的影响。结果 :柿叶可缩短出、凝血时间 ;使正常和妊娠大鼠离体子宫收缩频率幅度增加 ;使家兔在体子宫活动力加强 ,振幅加大 ,基线升高 ;具有明显的抗炎作用。结论 :柿叶有明显的止血、抗炎和促进子宫收缩的作用。     

柴胡止血液对置含铜IUD家兔宫腔液PGI_2和TXB_2含量的影响

为探讨柴胡止血液治疗宫内节育器所致子宫异常出血的作用机理,采用放射免疫法对照观察了柴胡止血液对置含铜宫内节育器(TCuIUD)家兔子宫宫腔冲洗液前列环素(PGF_(1α))和血栓素(TXB_2)含量的影响。结果表明置 TCuIUD后家兔子宫宫腔液中PGF_(1α)含量较未置器对照组明显增高(P<0.01),而TXB_2含量则明显降低(P<0.01),PGF_(1α)/TXB_2比值亦显著高于对照组(P<0.01);经柴胡止血液治疗后,家兔子宫宫腔冲洗液中PGF_(1α)含量与置器对照组比较明显降低(P<0.01),TXB_2含量则明显升高(P<0.01),PGF_(1α)/TXB_2比值亦趋于正常(与置器组比较,P<0.01;与对照组比较,P>0.05)。提示柴胡止血液对置TCuIUD家兔宫腔液的前列环素含量具有较强的调整作用,能使明显升高的PGF_(1α)及明显降低的TXB_2恢复正常,从对抗前列环素的角度阐明了柴胡止血液具有治疗IUD所致子宫出血的作用。     

中药消炎止血胶囊治疗宫内节育器致子宫异常出血的临床及实验研究

将宫内节育器(IUD)致月经前后淋漓出血的患者随机分为二组。实验组服用消炎止血胶囊,对照组服用安络血。另选择IUD致月经前后淋漓出血者11例,分别取其服药前和服药后子宫内膜组织,在光镜及电镜下观察子宫内膜和组织形态学的变化。结果服用消炎止血胶囊治疗IUD致月经前后淋漓出血总有效率为86.0％,而对照组安络血总有效率为43.7％,两组疗效差异有显著性,光电镜下观察消炎止血胶囊有明显的消炎、止血作用。结论:消炎止血胶囊对IUD致月经前后淋漓出血疗效显著,值得大力推广。     

中药消炎止血胶囊治疗药物流产后阴道出血的临床研究

目的 :观察中药消炎止血胶囊用于治疗药物流产后阴道出血的临床效果。方法 :将符合药物流产指征的 2 2 0例早孕妇女 (中医辩证属血瘀型 )随机分为研究组 112例 ,对照组 10 8例。研究组在孕囊排出后加服中药消炎止血胶囊 4粒 (1 2 g) ,对照组加服安络血胶囊 1粒 (5mg) ,比较两组临床疗效及随访结果 ,并进行统计分析。结果 :研究组治疗药物流产后阴道出血总有效率 87.5 % ,显著高于对照组 31.5 % ,差异有统计学意义 (P <0 0 5 ) ;研究组阴道平均出血时间 9.76± 4 .82天 ,显著短于对照组 15 .5 6± 6 .4 0天 ,差异有统计学意义 (P <0 .0 5 ) ;阴道出血量研究组与对照组比较有显著性差异(P <0 0 5 ) ;药物流产后第 14天超声检查两组比较有显著性差异 (P <0 .0 1)。结论 :中药消炎止血胶囊能缩短药物流产后阴道出血时间 ,减少阴道出血量 ,疗效显著。     

放置宫内节育器后子宫异常出血相关因素分析

目的:分析放置宫内节育器(IUD)后发生子宫异常出血的影响因素。方法:将因使用IUD而发生子宫异常出血的妇女65例作为观察组,使用IUD而无不良反应的妇女60例作为对照组。通过病例资料和拟定的调查问卷表分析放置IUD后子宫异常出血的危险因素。结果:两组年龄、放置IUD后用药、人工流产次数、高血压史、吸烟史等比较无统计学差异(P0.05)。观察组妇科炎症、剖宫产史比例均大于对照组,放置IUD时间低于对照组(P0.05)。单因素和多因素logistic回归分析结果表明,使用IUD后子宫不规则出血的危险因素为妇科炎症、剖宫产史和放置IUD时间。结论:对放置IUD后子宫异常出血的妇女,应积极给予治疗,放置IUD时充分考虑到妇科炎症、剖宫产史和放置IUD时间,做好术前咨询和术后随访工作,提高IUD的续用率。     

生化丸加云南白药胶囊用于药物流产的临床观察

目的观察生化丸加云南白药胶囊用于药物流产的临床效果。方法将320例自愿要求药物流产．无米非司酮和米索前列醇禁忌症的健康早孕妇女随机分为观察组和对照组,各160例。两组药物流产均采用相同服药剂量和方法。观察组在顿服米索前列醇时加服生化丸和云南白药胶囊;对照组则不加服任何药物。比较两组疗效并进行统计分析。结果观察组的完全流产率（96．87％）高于对照组的完全流产率（90．63％）,比较差异有统计学意义（P〈0．05）;观察组子宫出血量及出血时间优于对照组,两组比较差异有统计学意义（P〈0．005）。结论生化丸加云南白药胶囊能提高药物流产的完全流产率,减少药物流产子宫出血量,缩短子宫出血时间,疗效显著。     

剖宫产术后1年内行人工流产妇女术后放置IUD的避孕效果观察

目的 探讨剖宫产术后1年内行人工流产患者术后立即放置宫内节育器(IUD)的避孕效果.方法 选取2015年8月至2016年7月于安徽省马鞍市妇幼保健院就诊的人工流产术后立即放置IUD妇女480例,根据患者有无剖宫产史及剖宫产术后时间将所有患者分为A、B、C三组,剖宫产术后12个月内为A组,剖宫产术后12个月以上为B组,无剖宫产史的患者为C组.对比分析所有人工流产患者术后立即放置IUD的避孕效果和副作用.结果 置入IUD后1个月中,A组患者经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率高于其他两组,但差异无统计学意义(χ2值分别为0.28、0.01、0.14、0.01、0.07,均P>0.05).三组患者在3个月及以后时间点发生经期延长、经量增加、腰腹痛、不规则出血和白带增多的发生率比较,差异无统计学意义(χ2值分别为0.16、0.05、0.07、0.01、0.23,均P>0.05).所有患者在随访期间无出现闭经(宫腔粘连)的情况.三组患者置入IUD后,术后6个月时因疼痛或因出血取出率最高,三组之间比较差异无统计学意义(χ2=0.02,P>0.05).在随访期间,所有患者均未出现带器妊娠0.置入IUD后,B组在术后3个月内完全脱落2例,其余患者未发生完全脱落及部分脱落情况.至术后12个月时,三组患者累计续用率比较差异无统计学意义(χ2=0.92,P>0.05).结论 剖宫产术后1年内行人工流产的患者术后立即放置IUD是安全、可行的.     

IUD (Nova-T) insertion following induced abortion

In a prospective study, 86 women who had an IUD (Nova-T) inserted immediately after induced abortion were compared to 95 abortion patients who started another contraception (control I). Additionally, the rate of complications following IUD insertion in a Family Planning Clinic (control II) were studied in 83 non-pregnant women. The overall infection rate for post-abortion patients was 4.4% (5.8% in the study group, 3.2% in control I). No infections were observed in control group II. Confidence limits (95%) for the three groups were overlapping. Among the women in the study group, bleeding and pain were not more frequent, but if one of these complications occurred, it tended to be more serious and the duration was longer. The number of days before resumption of work after abortion was 3-4 days in both abortion groups. After three months, the continuation rate was 83% (71 of 86) in the study group, 76% (72 of 95) in control I and 93% (77 of 83) in control II. Sixty-nine of the 181 women admitted for legal abortion had been admitted for the same reason previously. In this study, the recurrence rate after 12 months was 0% in the study group and 4.2% (4 of 95) in control group I. The insertion of an IUD at the time of abortion seems to be an effective and acceptable solution to the problem of recurrent abortion.     

Intrauterine contraceptive insertion postabortion: a systematic review

Background

This review was conducted to evaluate the evidence regarding the safety and effectiveness of intrauterine device (IUD) insertion immediately following spontaneous or induced abortion.

Study Design

We searched MEDLINE databases for all articles (in all languages) published in peer-reviewed journals from January 1966 through March 2010 for evidence comparing immediate postabortion IUD insertion with either no IUD insertion, insertion at a different time, insertion following first-trimester compared with second-trimester abortion or copper IUD insertion compared with hormone-releasing IUD insertion postabortion. We used standard abstraction forms to summarize and assess the quality of the evidence.

Results

The search strategy identified a total of 990 articles, of which 19 met our inclusion criteria for this review. Studies comparing immediate postabortion IUD insertion with no IUD insertion found that both groups experienced similar rates of pain and infection and a similar number of bleeding days, but one study reported that women with copper IUD insertion experienced a greater amount of bleeding than women without IUD insertion after abortion. Results from studies comparing immediate postabortion IUD insertion and insertion at a time not associated with pregnancy did not report differences between the two groups in the duration of bleeding, pain, expulsions or pelvic inflammatory disease (PID). One study however reported a greater amount of bleeding and another reported more removals for medical reasons among women with postabortion IUD insertion. Evidence from studies that examined immediate vs. delayed postabortion insertion reported minimal differences in bleeding, pain, expulsion and PID between groups. Studies comparing immediate IUD insertion after first- vs. second-trimester abortion reported no difference in removals for pain and bleeding, and an increased risk of expulsion among those women who had insertions after second-trimester abortion. In addition, women with insertions immediately after abortions occurring later in the first trimester had higher expulsion rates than those with insertions after early first-trimester abortions. Studies examining women using a copper IUD compared with a hormone-releasing IUD reported inconsistent results, with one paper reporting more bleeding days in the copper IUD group and another finding higher rates of removal for bleeding in the progesterone-releasing IUD group.

Conclusion

Intrauterine device insertion immediately after abortion is not associated with an increased risk of adverse outcomes compared with use of other contraceptive methods or with no IUD insertion after abortion and compared with IUD insertion at times other than immediately after abortion. Intrauterine device expulsion rates, while generally low, were higher with insertions that occurred after later first-trimester abortion compared with after early first-trimester abortion and higher with IUD insertion after second-trimester abortion compared with after first-trimester abortion.     

海墨止血片对药物流产后出血时间影响的临床观察

目的:探讨海墨止血片对早孕药物流产后出血时间的影响。方法:采用随机、双盲方法进行临床对照试验。200例终止早孕对象药物流产后按1:1随机化顺序号分为观察组和对照组,药物流产孕囊排出后第3天晚起,两组分别加服海墨止血片或安慰剂2片/次,3次/日,共6天。结果:完全流产率观察组为95.24％,对照组为95.65％,两组比较无显著性差异(P>0.05);完全流产出血时间观察组为11.61±4.96天(4～33天),对照组为13.85±5.50天(7-34天),差异有显著性(P<0.05);出血时间≤14天者,观察组78.8％,对照组60.3％,两者比较有显著性差异(P<0.05)。结论:药物流产后加服海墨止血片可减少流产后出血时间。     

Evaluation of postabortion IUD insertion in Egyptian women

This study was carried out at Alhussein University Hospital and Elmonera General Hospital to assess the safety and efficacy of intrauterine device (IUD) insertion immediately after spontaneous abortion compared with insertion 2 weeks after abortion. One hundred women between ages 18 and 40 years were recruited from those admitted via the emergency room with first trimester spontaneous abortion. All women were counseled about a method of contraception, particularly copper T-380, and divided into two groups: Group I, which included 69 women who preferred immediate IUD insertion, and Group II, which included 31 women who asked for late IUD insertion 2 weeks after an abortion. All women were followed at 2, 6, and 10 weeks after insertion of IUDs. Bleeding patterns were comparable in both groups. Mild bleeding occurred in 9.2% and 16% in Groups I and II, respectively; moderate bleeding occurred in 80% and 64%, respectively, and severe bleeding was observed in 10.8% and 20%, respectively. This was not significant. Expulsion rate was 4.5% and 3.4% in Groups I and II, respectively, which was also not significant. There were no cases of perforation or pelvic infections. This study showed that insertion of an IUD immediately after a spontaneous abortion is safe and could be offered to those who have had an abortion and who ask for a method of contraception.     

米非司酮药物流产后子宫异常出血与内膜MMP-9、TIMP-1的关系研究

目的：研究米非司酮药物流产后子宫内膜基质金属蛋白酶-9（MMP-9）和基质金属蛋白酶特异性组织抑制物-1（TIMP-1）的表达变化,探讨药物流产后子宫异常出血的机理。方法：取药物流产（简称药流）后和吸宫术后子宫出血〉14天妇女各20例以及药物流产后子宫出血≤14天20例妇女的子宫内膜,应用免疫组化二步法测定子宫内膜MMP-9和TIMP-1的表达,对3组子宫内膜MMP-9和TIMP-1表达进行组织学积分测定。结果：药流非出血组、药流出血组和吸宫出血组子宫内膜组织中MMP-9的表达依次下降（P〈0.05）,TIMP-1表达3组间无差异,3组子宫内膜中MMP-9/TIMP-1组织学积分比值分别为1.47、1.00、1.14。MMP-9/TIMP-1比值药流出血组高于其它两组（P〈0.05）,而药流出血组和吸宫出血组之间子宫内膜MMP-9/TIMP-1比值无差异。结论：子宫内膜MMP-9的下降和MMP-9/TIMP-1比值降低与人工流产术后的子宫出血有关,并非是药物流产后子宫出血所特有的内膜局部因子改变。