雌激素与雌孕激素联合治疗青春期功能失调性子宫出血的比较分析

目的：比较雌激素与雌孕激素联合治疗青春期功能失调性子宫出血的临床疗效。方法收集2013年3月~2014年3月本院收治的64例青春期功能失调性子宫出血患者临床资料,按照不同的治疗方法,将患者分为对照组与治疗组,每组例数均为32例。对照组患者采取孕激素治疗,治疗组患者雌孕激素联合治疗,最后分析两组患者的临床治疗效果。结果治疗组患者治疗总有效率为96.87%,对照组治疗总有效率为87.60%,差异有统计学意义(<0.05)。治疗组患者控制出血时间、完全止血时间、住院时间明显短于对照组,差异有统计学意义(<0.05)。治疗组患者止血失败率明显低于对照组,差异有统计学意义(<0.05)。治疗组患者不良反应发生率明显低于对照组,差异有统计学意义(<0.05)。结论雌孕激素联合治疗青春期功能失调性子宫出血,止血效果良好,有利于改善患者临床症状,提高治疗效果,缩短治疗时间,改善患者预后情况,值得临床推广。     

妈富隆治疗青春期功血45例临床分析

目的 探讨妈富隆治疗青春期功血的止血效果及患者月经的恢复时间.方法 回顾我院2005年1月～2010年6月在妇科就诊,使用妈富隆治疗的45例青春期功血与同期使用倍美力治疗的43例青春期功血进行比较分析,观察两组患者的止血效果及月经恢复时间.结果 妈富隆的患者控制出血时间及完全止血的时间明显短于倍美力组(P＜0.05).妈富隆组止血全部成功,倍美力组有3例止血失败.结论 妈富隆治疗青春期功血,在止血效果及调整月经周期明显优于使用雌激素治疗,且妈富隆价格适中,服用方便,便于推广.     

补肾活血药对青春期功血患者ET水平的影响

神经内分泌机制调节失常是青春期功能失调性子宫出血发生的主要原因。而内皮素 (ＥＴ)的释放同心血管、神经内分泌等多系统疾病有着密切的联系。临床实践表明 ,补肾活血药对青春期功血有着良好的治疗效果。为进一步探讨中医药治疗青春期功血的作用机制 ,本实验观察补肾活血药治疗青春期功血前后ＥＴ水平的动态变化 ,并探讨ＥＴ在该病发生、发展中的作用及中医药治疗青春期功血的实验依据。材料和方法一、临床资料 :(一 )患者情况 :均为我院妇科门诊病人 ,共 4 3名 ,年龄12～ 17岁。根据病史、症状、体征明确诊断为青春期功血。(二 )治疗方法…     

冠状动脉介入治疗缺血性心肌病顽固性心力衰竭的临床分析

目的分析冠状动脉介入治疗缺血性心肌病顽固性心力衰竭的临床效果。方法选取116例缺血性心肌病顽固性心力衰竭患者。对照组:行常规药物治疗;观察组:行冠状动脉介入手术治疗。结果观察组的治疗有效率是91.38%明显高于对照组的70.69%(P0.05);观察组患者治疗后的左室射血分数、左室舒张末内径、X线心胸比指标情况要优于对照组(P0.05)。对照组的不良反应发生率是13.79%,观察组的不良反应发生率是3.44%(P0.05)。结论冠状动脉介入治疗缺血性心肌病顽固性心力衰竭效果显著,能有效的改善患者的心功能情况,提高生存质量,近期治疗效果较好。     

应用三相避孕药治疗功血的临床分析

目的观察其止血效果,不良反应及停药后复发情况。方法应用先灵（广州）药业有限公司生产的复方三相避孕片特居乐对40例功血患者进行治疗。结果所有病例8～48h出血量减少,8～72h出血停止.撤药后3～6d再次来月经,周期调控在28～31d,出血类型符合正常月经规律。无1例间期出血及撤药后大出血。不良反反应小。停药后6个月未发现功血复发。8例无排卵型功血监测显示有排卵。结论国产三相避孕片治疗功血起效快,能有效控制月经周期,停药后能促进卵巢排卵,防止功血复发。     

达英35治疗育龄期妇女功血的临床分析

目的：探讨达英35治疗育龄期妇女功血的临床分析。方法分析2008年1月~2012年12月在我院诊治的育龄期功血54例患者,将本组患者随机分成对照组和观察组,每组各27例。观察两组患者的临床效果。结果观察组育龄期功血患者的总有效率(91.7%)明显高于对照组患者的总有效率(73.3%)(冂2=4.627,=0.016<0.05),两组间的差异具有统计学意义。结论达英35对于治疗育龄期功血患者具有较高的临床疗效,值得再临床上推广使用。     

米非司酮治疗围绝经期功能失调性子宫出血疗效

目的：探讨米非司酮治疗围绝经期功能失调性子宫出血的疗效。方法随机将110例围绝经期功血患者分为两组,每组55例。观察组在诊刮术后口服6.25mg米非司酮,连续4个月;对照组采用后半期周期疗法,诊刮术后15d,服用10mg醋酸甲羟孕酮,连续10d,待撤退性出血后15d,开始下个周期治疗,疗程3个月。比较两组临床治疗效果及不良反应。结果两组患者临床症状均有明显改善,但观察组治疗总有效率显著优于对照组,差异有统计学意义(P<0.05)。结论通过评价分析发现采用诊刮联合米非司酮治疗围绝经期功能性子宫出血,能够显著提高治疗总有效率,降低复发率,值得在临床上推广应用。     

阿奇霉素联合阴道栓剂在非淋菌性宫颈炎治疗中的临床疗效

目的：探讨阿奇霉素联合阴道栓剂在治疗非淋菌性宫颈炎的临床疗效。方法将我院于2013年6月~2014年6月收治的91例非淋菌性宫颈炎患者随机分为研究组46例和对照组45例,研究组患者采用阿奇霉素联合阴道栓剂治疗,对照组患者单一阿奇霉素治疗,两组疗程均为2w,疗程结束后7d观察临床治疗效果及不良反应发生情况。结果研究组的治疗总有效率为89.1%(41/46),对照组的治疗总有效率为68.9%(31/45),对比差异有显著,具有统计学意义(P>0.05);不良反应发生率研究组患者为3例,表现为恶心、头痛头晕、转氨酶增高,对照组患者不良反应4例,两组差异不显著(P>0.05)。结论阿奇霉素联合阴道栓剂治疗非淋菌性宫颈炎的临床疗效显著,不良反应发生较少,临床可广泛应用。     

126例沐舒坦结合细辛脑注射液治疗小儿支气管肺炎的临床效果

目的 研讨沐舒坦结合细辛脑注射液治疗小儿支气管肺炎的临床效果.方法 随机抽选我院2008年6月~2010年6月收治的126例支气管肺炎患儿,将其按就诊时间先后分为63例对照组(沐舒坦组)和63例观察组(联合用药组),治疗周期为2周,比较两组患儿的治疗效果.结果 对照组痊愈21例,显效19例,总有效率为63.5%;观察组痊愈37例,显效18例,总有效率为87.3%,两组比较差异显著(P<0.01),具有统计学意义.对照组和观察组的不良反应发生率分别为3.2%和4.8%,两组比较差异无统计学意义(P>0.05).结论 沐舒坦结合细辛脑注射液治疗小儿支气管肺炎治疗效果显著,且不良反应无明显增加,值得在临床上推广使用.     

成人颞叶癫痫术后奥卡西平单药治疗的效果观察

目的:探究奥卡西平单药治疗术后成人颞叶癫痫的临床疗效。方法:回顾性分析本院2011年6月~2014年11月期间就诊的50例成人颞叶癫痫术后患者的临床资料,其中观察组(采用奥卡西平单药治疗)和对照组(采用卡马西平单药治疗)各25例,比较两组患者的临床治疗效果及不良反应情况。结果:观察组25例患者中,有5例患者临床治疗显效,有16例患者临床治疗有效,总有效率为84%;而对照组25例患者中,只有2例患者临床治疗显效,13例患者临床治疗有效,总有效率为60%,两组之间的治疗效果差异明显(P0.05),具有统计学意义。同时,观察组患者的不良反应率为40%,明显低于对照组患者的不良反应率(80%)(P0.05)。结论:奥卡西平单药治疗术后成人颞叶癫痫的临床疗效显著,能够有效的降低不良反应率,改善患者的生活质量。     

微粒化黄体酮治疗闭经及无排卵性异常子宫出血的疗效

目的 分析口服微粒化黄体酮胶囊治疗闭经及无排卵性异常子宫出血的临床疗效。方法 选取2015年6月~2018年6月在我院诊治的116例闭经及无排卵性功能失调性子宫出血患者为研究对象,采用随机数字表法分为对照组和观察组,各58例。对照组采用醋酸甲羟孕酮片治疗,观察组口服微粒化黄体酮胶囊治疗,比较两组治疗前后月经周期指标（月经周期、子宫内膜厚度、月经期）、内分泌功能指标[血清卵泡雌激素（FSH）、黄体生成素（LH）及雌二醇（E2）水平及不良反应。结果 治疗后两组月经周期、子宫内膜厚度、月经期均低于治疗前,且观察组低于对照组（P＜0.05）;治疗后两组FSH、LH、E2均低于治疗前,且观察组低于对照组（P＜0.05）;观察组不良反应发生率（10.34%）与对照组（12.06%）比较,差异无统计学意义（P＞0.05）。结论 口服微粒化黄体酮胶囊在调控闭经及无排卵性功能失调性子宫出血中具有确切的疗效,可缩短月经周期、月经期,减小子宫内膜厚度,且不良反应少,具有临床应用价值。     

Endometrial lysosomal enzyme activity in ovulatory dysfunctional uterine bleeding, IUCD users and post-partum women

The aim of this study was to evaluate the role of lysosomal enzymes in excessively heavy menstruation by comparing women with menorrhagia due to dysfunctional bleeding or intrauterine contraceptive device (IUCD) use with those with normal menstrual periods or with amenorrhoea associated with breastfeeding. This was a prospective cohort investigation of the activity of four endometrial lysosomal enzymes in three contrasting groups: (i) women with ovulatory dysfunctional uterine bleeding and users of intrauterine contraceptive devices; (ii) breastfeeding post-partum women in whom there are long periods of amenorrhoea, particularly in the early months post-partum; and (iii) normal cycling women. It was found that the total activity of lysosomal enzymes, particularly acid phosphatase and N-acetyl-beta-D-glucosaminidase, was markedly elevated (P < 0.001) in IUCD-exposed endometrium, and endometrium from women with dysfunctional uterine bleeding when compared with endometrium from women with a history of entirely normal menstrual periods or that in post-partum breastfeeding women. The activity of alpha-L-fucosidase was moderately elevated in IUCD users (P < 0.05) and ovulatory dysfunctional uterine bleeding (P < 0.05), whereas alphaD-mannosidase activity was elevated in ovulatory dysfunctional uterine bleeding (P < 0.05), but decreased in IUCD users (P < 0.01). No significant differences were observed in the lysosomal enzyme activities of breastfeeding post-partum women and normal cycling women. These results show that total endometrial tissue activity of four lysosomal enzymes was substantially increased throughout the cycle in most circumstances in women with two different causes for increased menstrual bleeding. This suggests a contributory role to the increased bleeding.     

左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床观察

目的 观察左炔诺孕酮宫内缓释系统治疗子宫腺肌病的临床疗效。方法 回顾分析2018年1月~2019年1月在我院诊治的90例子宫腺肌病患者临床资料,采用左炔诺孕酮宫内缓释系统治疗,观察治疗后1个月、3个月、6个月痛经评分、月经量、子宫体积、CA125、Hb以及不良反应。结果 治疗后1个月、3个月、6个月痛评分降低、月经量减少、子宫体积缩小,与治疗前比较,差异有统计学意义（P＜0.05）;治疗后1个月、3个月、6个月CA125水平降低,Hb水平升高,与治疗前比较,差异有统计学意义（P＜0.05）;随诊6个月,4例出现阴道不规则出血,2例出现节育器下移,1例乳房胀痛,不良反应发生率为7.78%,临床给予针对性的处理后好转。结论 左炔诺孕酮宫内缓释系统治疗子宫腺肌病疗效确切,不良反应少,是临床治疗子宫腺肌病的有效安全的保守治疗方法。     

子宫动脉栓塞联合宫腔镜治疗子宫切口妊娠的疗效分析

目的 分析子宫动脉栓塞联合宫腔镜治疗子宫切口妊娠的临床疗效。方法 选取50例汉川市第二人民医院2015年9月~2017年5月收治的子宫切口妊娠患者,通过随机方式将其分为常规组和联合组,各25例,给予常规组患者肌注氨甲蝶呤及B超检测下清宫术治疗,给予联合组患者子宫动脉栓塞联合宫腔镜下清宫术治疗,观察两组患者术中各指标水平,不良反应发生情况。结果 联合组患者各手术指标术中出血、阴道流血时间、血β-HCG转阴时间水平均低于常规组患者,差异有统计学意义（P＜0.05）;联合组患者不良反应发生率低于常规组患者,差异有统计学意义（P＜0.05）。结论 子宫动脉栓塞联合宫腔镜治疗子宫切口妊娠的临床疗效显著,能有效降低术中出血量,加快患者术后恢复,且具有较高的安全性,临床价值较高。     

曲普瑞林联合屈螺酮炔雌醇在子宫腺肌症患者辅助治疗过程中的应用效果探究

目的:探讨曲普瑞林联合屈螺酮炔雌醇在子宫腺肌症患者辅助治疗过程中的应用效果。方法:选取2018年10月至2020年2月我院子宫腺肌症患者96例,依据随机数字表法分为研究组(n=48)及对照组(n=48)。两组均采取左炔诺孕酮宫内节育系统,在此基础上对照组采取屈螺酮炔雌醇,研究组在对照组基础上采取曲普瑞林,均治疗6m。统计两组临床疗效、治疗前及治疗6m后血清生化指标(卵泡雌激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、前列素F-2α(prostaglandin E-2α,PGE-2α)、糖类抗原125(carbohydrate antigen 125,CA125))水平、子宫内膜厚度与子宫体积、痛经程度、月经量、不良反应发生率。结果:研究组总有效率(93.75%)高于对照组(79.17%)(P<0.05)。治疗6m后两组血清FSH、LH、PGE-2α、CA125水平较治疗前降低,且研究组低于对照组(P<0.05)。治疗6m后两组月经量较治疗前减少,VAS分值较治疗前降低,子宫内膜厚度及子宫体积较治疗前缩小,且研究组各项指标改善幅度较对照组更明显(P<0.05)。研究组不良反应发生率(12.50%)与对照组(8.33%)间无显著差异(P>0.05)。结论:联合采取曲普瑞林及屈螺酮炔雌醇治疗子宫腺肌症效果显著,具有安全性。     

Management of abnormal genital bleeding in girls and women

Management of abnormal genital bleeding in girls, adolescents and women, in pregnancy, and in postmenopausal women is reviewed under the headings of evaluation and treatment. In childhood all genital bleeding is clinically significant: it is due to acute infection, foreign bodies, trauma, prolapsed urethra or precocious puberty, rarely to tumors. Bleeding in adolescents and adults is most often due to anovulation, usually estrogen-breakthrough bleeding. Other causes are submucosal leiomyomas, cervical or endometrial polyps, lacerations, uterine or cervical cancer, or systemic disorders such as hypothyroidism or bleeding disorders. Evaluation of bleeding in children requires skill and often general anesthesia, especially if peritoneal laceration is suspected. The 1st step in adolescents and adults is to rule out pregnancy. Pap smears are insufficient: biopsies are advised, especially endometrial biopsies in women 40. Hemoglobin, hematocrit and thyroid status, should also be ordered. Specific treatments involve antibiotics for infection, correction of anemia and orthostatic hypotension, reversal of unopposed estrogen, and medical treatment of menorrhagia and dysfunctional bleeding that does not involve hemodynamic instability. Sometimes curettage, endometrial ablation or hysterectomy is needed. Medical management of breakthrough bleeding caused by unopposed estrogen is high dose estrogen followed by progestin therapy to bring about withdrawal, curettage if necessary, then cyclic combined therapy. In young women 4 birth control pills per day for 5-7 days are often prescribed, with cyclic therapy after withdrawal bleeding is obtained. Prostaglandin inhibitors reduce menstrual loss 50%. Endometrial atrophy in post-menopausal women is treated with cyclic conjugated estrogens and then medroxyprogesterone acetate for 10-13 days per month, or continuous combined therapy for those who can tolerate it.     

Current treatment of dysfunctional uterine bleeding

OBJECTIVES: We performed a review of the treatment modalities for dysfunctional uterine bleeding. METHODS: Dysfunctional uterine bleeding can be treated medically or surgically. Medical treatment consists of anti-fibrinolytic tranexamic acid, non-steroidal anti-inflammatory drugs, the combined contraception pill, progestogen, danazol, or analogues of gonadotrophin releasing hormone. The levonorgestrel releasing intra uterine device is developed for contraception, but is also effective in the treatment of dysfunctional uterine bleeding. Surgical treatment includes endometrial ablation of the first and second-generation, and hysterectomy. This review contains current available evidence on the effectiveness of these therapies. RESULTS: Antifibrinolytic tranexamic acid is the most effective medical therapy to treat dysfunctional uterine bleeding. In general medical therapy is not as effective as endometrial resection in terms of patient satisfaction and health related quality of life. The levonorgestrel releasing intra uterine device is an effective treatment for dysfunctional uterine bleeding. No difference in quality of life was observed in patients treated with a levonorgestrel releasing intra uterine device as compared to hysterectomy. Ablation techniques of the first generation are effective and safe when used by trained surgeons, but have a learning curve. Ablation techniques of the second generation are effective, but long-term follow-up data are not available. Similarly, there are no large randomised controlled trials comparing the levonorgestrel releasing intra uterine device to first and second-generation ablation techniques. Hysterectomy, the traditional standard of care, has a relatively high complication rate, but it generates a high satisfaction rate and good health related quality of life scores. CONCLUSION: Since none of the treatments for dysfunctional bleeding is superior to one of the others, and since all treatments have their advantages and disadvantages, counselling of patients with dysfunctional bleeding should incorporate medical approach, levonorgestrel releasing IUD, endometrial ablation and hysterectomy.     

舍曲林治疗青少年网络成瘾的随机、双盲、对照临床研究

目的:评价舍曲林治疗青少年网络成瘾的有效性及安全性。方法:采用随机对照双盲试验,共纳入青少年网络成瘾患者64人,按就诊或入院先后顺序编号。按完全随机法(应用SPSS软件随机抽样分组)将纳入患者随机编入研究组(舍曲林治疗组,剂量为50~100mg/d)和对照组(安慰剂治疗组),每组32例,治疗8周。分别于治疗前和治疗8周后评估每周上网时间,采用中文网络成瘾量表修订版(Chinese Internet Addiction Scale-Revised,CIAS-R)评估成瘾程度,焦虑自评量表(SAS)及抑郁自评量表(SDS)评估焦虑抑郁情绪,副反应反应量表(TESS)评定不良反应。结果:治疗结束后,研究组每周上网时间从治疗前的(34.3±6.4)小时下降至(9.1±5.7)小时(t=17.45,P0.01),CIAS-R量表总分及5个维度(强迫性上网行为、网络成瘾耐受性、戒断反应、人际与健康、时间管理分)分值较治疗前均有显著性降低(P0.01),SAS、SDS量表总分也较前显著性降低(t=5.935,10.226;P0.01)。与对照组相比,治疗结束后研究组每周上网时间、CIAS-R总分及各维度分、SAS、SDS量表分均显著性降低,差异有统计学意义(P0.01)。治疗期间研究组药物不良反应的发生率为18.75%(6/32),主要为胃肠道不适、嗜睡及出汗,未发生严重不良反应。结论:舍曲林治疗青少年网络成瘾能明显减少患者上网时间,改善患者焦虑抑郁情绪,明显减轻患者对网络的成瘾程度,且安全性好,值得进一步深入研究。     

Contraceptive potential of a mifepristone-nomegestrol acetate sequential regimen in women

The effectiveness of a sequential regimen consisting of mifepristone, 10 mg/day for 15 days, followed by nomegestrol acetate (NOMA), 5 mg/day for the next 13 days, for inhibiting ovulation and maintaining regular bleeding cycles was assessed in 10 surgically sterilized volunteers who were followed for one pretreatment and three treated cycles. Hormonal determinations in blood and urine, ovarian ultrasonography, bleeding records in all cycles and an endometrial biopsy taken on day 22-25 of the third treatment cycle were used to monitor the effects of treatment. During treatment, 24 monophasic (no sustained progesterone rise above 12 nmol/l) and six biphasic cycles were recorded. Nine follicular ruptures were detected echographically in these 30 treated cycles, five of which occurred in monophasic cycles. All follicular ruptures occurred on days 1-7 of NOMA treatment. Echographic and endocrine features of ovulatory cycles were both present in only four treated cycles (13.3%). Development of a secretory endometrium was achieved in all cases, but it was always irregular. Regular withdrawal bleeding occurred in all subjects and no adverse reactions were recorded. The ovarian and endometrial effects of this regimen justify testing its contraceptive effectiveness in phase 2 clinical trials.      

国产与进口氯吡格雷对冠状动脉支架置入后影响的等效性比较：1 798例总结

背景：有研究显示国产氯吡格雷与进口氯吡格雷在冠状动脉支架置入后的应用中具有相似的疗效及安全性,但国内尚缺少二者对冠状动脉支架置入后疗效及安全性的前瞻性大规模、大样本临床对比研究。 目的：探讨等剂量国产和进口氯吡格雷对冠状动脉支架置入后的疗效及安全性是否相同。 方法：前瞻性入选1 798例接受冠状动脉支架置入治疗的冠状动脉粥样硬化性心脏病患者,分为国产氯吡格雷组(n=1 104)及进口氯吡格雷组(n=694),在冠状动脉支架置入前给予300 mg负荷剂量,序贯75 mg/d,随访3-28个月,观察对急性、亚急性、晚期、极晚期支架内血栓和心肌梗死、心源性死亡、脑卒中联合终点事件及出血等相关不良反应的影响。 结果与结论：两组支架内血栓、靶血管重建、心源性死亡、出血和大出血事件及联合终点事件发生率差异无显著性意义,两组无事件生存率差异无显著性意义。两组治疗后的白细胞计数、红细胞计数、血红蛋白、红细胞压积、血小板计数均低于治疗前(P < 0.05),且国产氯吡格雷组血红蛋白较进口氯吡格雷组下降明显(P < 0.05)。表明等剂量国产与进口氯吡格雷对经皮冠状动脉支架置入后的疗效及安全性相似。