卵巢为奇恒之脏之我见

卵巢是女性重要的内生殖器,通过从隶属关系、藏泄功能、卵巢藏泄失司与排卵功能障碍3个方面论述卵巢应为奇恒之脏,其功能分藏泄两方面,受肝的疏泄和肾的封藏调节,藏泄失常与卵巢排卵障碍有密切关系。     

二至天癸方对高龄不孕妇女卵巢反应性的影响

目的探讨补肾益天癸之二至天癸方提高高龄不孕妇女卵巢反应性的临床疗效。方法将66例参加体外受精-胚胎移植（IVF-ET）周期的高龄不孕妇女随机分为中药组（二至天癸方联合超排卵方案治疗,33例）和对照组（单用超排卵方案治疗,33例）,观察临床症状改善情况,促性腺激素（FSH）的用量,不同时期血清激素水平、HCG注射日子宫内膜厚度、子宫和卵巢动脉搏动测定,卵泡数,取卵数,优质卵率,受精率,优质胚胎率,妊娠率,并对治疗后两组患者阴中干涩症状积分与HCG注射日血清E2进行相关性分析。结果中药组患者临床肾气阴两虚症状得到有效改善,与对照组比较差异有显著性（P〈0．05）;中药组FSH总用量及每天FSH用量明显低于对照组,两组比较,差异有显著性（P〈0．05）;在HCG注射日血清E2水平、子宫内膜厚度、取卵数、优质卵率、受精率、优质胚胎率,中药组均明显优于对照组,差异有显著性（P〈0．05）;两组患者治疗后阴中干涩症状积分与HCG注射日血清E2水平均存在弱负相关关系（r=-0．369,r=-0．425）,说明HCG注射日血清E2水平是影响阴中干涩症状的因素,但不是唯一因素。中药组治疗后阴中干涩积分低于对照组,差异有显著性（t=2．422,P〈0．05）。结论二至天癸方配合超排卵方案可明显减少FSH用量,提高卵巢反应,改善卵子质量,提高妊娠率,提示其机理与补肾益天癸之二至天癸方改善卵巢反应性,提高雌激素水平,协调下丘脑-垂体-卵巢轴有关。     

Clinical observation on treatment of 50 patients with candidal vaginitis by Chinese herbal medicine combined with Canesten

From January 2001 to January 2002, 50 patients of candidal vaginitis were treated by Kushen powder (KSP, 苦参散) combined with Canesten as the treatment group, and controlled by a control group including another 50 patients treated with Canesten alone. The therapeutic results were satisfactory and reported as follows.     

空卵泡综合征的最新研究进展

现代辅助生殖技术的进步为不孕症治疗做出了巨大贡献,但治疗中如果发生空卵泡综合征(EFS),则无法从成熟的卵泡中获取卵母细胞。虽然EFS比较罕见,但由于无法使用超声波或血清激素水平进行预测,而且EFS发生机制尚不明确,因此一直是辅助生殖技术中需要解决的难题之一。关于EFS的发病机制医学界尚无确切定论。最早2008年Stevenson首次将FES详细区分为真性和假性,并提出真性空卵泡综合征(GEFS)的病因、治疗同假性空卵泡综合征(FEFS)有很大差别,这对EFS的病因、治疗及预后等方面的研究具有里程碑式的意义。GEFS的发生受多种因素影响包括年龄、卵巢状态、遗传等因素,此类患者预后较差且当前赠卵是可行的一种选择;FEFS主要是人为因素或药物因素导致,很大程度上可以避免,预后较GEFS好。本文对EFS的病因、治疗、预防及预后等方面进行综述。     

糖尿病产妇会阴切口感染病原菌与相关因素分析

目的探讨糖尿病产妇会阴切口感染的病原菌特点及相关因素。方法选择2013年4月-2017年1月于医院顺产并进行会阴侧切口的糖尿病产妇218例为研究对象,采集产妇术后会阴切口分泌物,进行病原菌鉴定。分析产妇年龄、体重指数(BMI)、孕周、产程、切口长度、住院时间、手术时间、手术出血量、发病季节、合并基础疾病、胎膜早破等临床资料,归纳糖尿病产妇会阴切口感染的相关因素。结果 218例糖尿病产妇会阴切口感染25例,感染率为11.47%,空腹血糖水平越高,糖尿病孕妇产后切口感染率越高(P0.001);共培养分离病原菌31株,其中革兰阳性菌18株占58.06%,革兰阴性菌9株占29.03%,真菌4株占12.90%。年龄、阴道或肛门检查次数、第二产程、血糖控制水平、术后住院时间及术前生殖道感染是糖尿病产妇会阴切口感染的相关因素(P0.05)。结论导致糖尿病产妇会阴切口感染的病原菌以革兰阳性菌为主,依据感染病原菌与相关因素进行综合干预,对于降低其切口感染率和提高产妇预后有着重要意义。     

中西医结合治疗免疫性不孕验案1则

正免疫性不孕症是指由于生殖系统抗原的自身免疫、局部免疫或同种免疫而引起的不孕症,在所有导致不孕的因素中约占10%~30%。西医主要采用免疫抑制疗法、避孕套隔绝疗法、宫腔内人工授精、体外受精等疗法,效果欠佳。近年来,随着对免疫性不孕症研究的不断深入,中医治疗取得较大进展。连方教授认为,脾肾两虚、冲任失调乃本病     

连方应用桂枝汤治疗慢性盆腔炎经验探析

盆腔炎是困扰广大女性的疾病。盆腔炎分为急性和慢性两种,临床以慢性盆腔炎多见。其具有病程长,病情缠绵,复发率高的特点。中医古籍无"盆腔炎"病名,根据其临床表现,可归属于"妇人腹痛"、"癥瘕"、"不孕"等病证中。中医在治疗盆腔炎具有明显优势,在缓解症状的同时又能避免西医长期使用抗生素引起的不良反映。本人跟随连方主任学习中,有幸发现其应用桂枝汤治疗慢性盆腔炎。连师认为久治不愈的慢性盆腔炎的主要原因是久病不愈,正气内耗,气血两虚,进而造成营卫不和。营卫不和,气机停滞,造成气滞血瘀最终盆腔炎反复发作。桂枝汤功能调和营卫,解肌发表。故临床治疗长期应用抗生素引起的久治不愈的慢性盆腔炎,常用桂枝汤加减。     

对一例多囊卵巢综合征患者在体外受精周期中卵泡发育迟缓并停滞的研究

多囊卵巢综合征(PCOS)是女性常见的内分泌紊乱性疾病。PCOS的不孕症患者在进行药物超促排卵的过程中,可能会出现卵巢过度刺激综合征(OHSS)或卵巢反应不良如卵泡发育迟缓甚至停滞发育的情况。因此,为提高PCOS患者使用辅助生殖技术中进行妊娠的成功率,医生在为其制定合理的药物超促排卵方案时,既要注意预防OHSS的发生,又要获得数量理想,质量高的卵泡。本文报道了1例PCOS患者在使用长方案进行药物超促排卵的过程中,出现卵泡发育迟缓并停滞的现象,针对这种情况医生为其肌肉注射HCG针10000u,并在注射药物24小时后取卵,并进行常规体外培植受精,并最终获得可用胚胎的过程。     

六味地黄颗粒改善肾阴虚不孕妇女体外受精前胚胎移植结果以及卵泡液蛋白质表达的作用

Objective:To observe the effects of Liuwei Dihuang Granule(六味地黄颗粒,LDG) for tonifying Kidney(Shen) on the outcomes of in vitro fertilization pre-embryo transfer(IVF-ET) of infertility women with Kidneyyin deficiency syndrome and to explore its mechanism by detecting the proteome expression in the follicular fluid.Methods:Sixty-six infertility patients of Kidney-yin deficiency syndrome who would undergo IVF-ET,were randomly assigned to a treatment group and a control group according to a random number table,33 cases in each group.Another 33 cases of non-Kidney-yin deficiency syndrome was taken as a syndrome-control group.Besides Western routine therapy,LOG was given 3 menstrual cycles before IVF to the treatment group,and a placebo granule to the control and syndrome-control groups.The scores of Kidney-yin deficiency symptoms(sore waist and knees,dry vagina,dysphoria with feverish sensation in the chest,palms and soles,etc.) were assessed,the number of retrieved oocytes,rates of high quality oocytes and embryos,fertility rate and clinical pregnancy rate were recorded,and the follicular fluid was collected on the day when the ovum was picked up,the drfferential protein expression was detected using two-dimensional gel electrophoresis,and then,matrix assisted laser desorption ionization time-of flight mass spectrometry(MALDI-TOF-MS) was applied to identify the proteins.Results:The syndrome score in the treatment group decreased significantly from 16.09 ±2.58 to 8.67 ±2.13,while it changed insignificantly in the control group,with a significant difference in the lowering score between the two groups(P0.05);the high quality rates of oocytes and embryos and clinical pregnancy rate were all superior in the treatment group to the control group(82.29%vs78.08%,76.76%vs 68.79%,63.64%vs 36.36%,all P0.05).The protein expression map from the follicular fluid showed that compared with the control group,33 differential protein expressions were found in the syndrome-control group,among which 18 were down-regulated,and 15 up-regulated;in the treatment group 28 differential protein expressions were found,among which 15 were down-regulated,and 13 up-regulated.Through MALDI-TOF-MS,14 proteins were identified(P0.05).Conclusions:For the infertility patients undergoing IVF,LDG could alleviate clinical symptoms,improve rates of high quality oocytes and embryos,so as to raise clinical pregnancy rate.The mechanism may be through regulating proteome expression in the follicular fluid to improve the developmental mkroenvironment for oocytes which would lead to a successful embryo implantation.     

中药提高卵泡发育质量的研究进展

在导师连方主任的指导下,根据相关文献综述卵泡发育异常的中药治疗规律。并从中药对卵泡发育异常的病因病机、辨证论治、专病专方、中药配合其他疗法等方面进行了整理和归纳。