益肾疏肝汤治疗围绝经期综合征临床观察

[目的]观察中药汤剂治疗围绝经期综合征的疗效。[方法]采用中药益肾疏肝汤治疗围绝经期综合征45例,并以45例单纯服用中成药妇宁康片为对照组。[结果]治疗组总有效率为97.78%,与对照组总有效率为82.22%相比,有显著性差异(P<0.05)。[结论]益肾疏肝汤治疗围绝经期综合征疗效明显优于中成药妇宁康片治疗。     

自凝刀子宫内膜射频消融术与宫腔镜子宫内膜电切术治疗围绝经期功血的临床疗效比较

目的:比较自凝刀子宫内膜射频消融术（BBT）与宫腔镜子宫内膜电切术（TCRE）治疗围绝经期功血的临床效果。方法:选取2015年5月-2016年12月在河南省许昌市建安区人民医院妇产科接受治疗围绝经期功血的患者96例,采用随机数字法分为对照组和观察组,每组患者各48例。对照组患者运用宫腔镜子宫内膜电切术治疗,观察组患者运用自凝刀子宫内膜射频消融术治疗。比较两组患者的临床疗效、治疗前后性激素水平、子宫内膜厚度、治疗前后血红蛋白水平、术中情况、住院时间及并发症情况。结果:观察组患者的总有效率为98%,对照组患者总有效率为94%,两组患者总有效率比较,差异无统计学意义（P>0.05）。两组患者性激素包括促卵泡激素（FSH）、促黄体素（LH）、睾酮（T）、催乳素（PRL）、孕酮（P）及雌二醇（E2）水平在治疗前、治疗后均无统计学差异（P>0.05）。 观察组患者术中出血量、手术时间及住院天数分别为（10.36±6.03）mL、（12.64±2.64）min、（2.15±1.29）d优于对照组（26.26±8.16）mL、（22.61±3.61）min、（3.64±1.74）d,差异有统计学意义（P<0.05）。观察组患者术后出血、发热等并发症发生率为2.08%低于对照组14.58%,差异有统计学意义（P<0.05）。两组患者治疗前子宫内膜厚度和血红蛋白水平比较无统计学差异（P>0.05）。观察组患者治疗后子宫内膜厚度[（3.49±0.97）mm]薄于对照组[（5.21±1.24）mm],患者治疗后,血红蛋白[（121.37±8.04）g/L]高于对照组[（101.51±10.28）g/L]（P<0.05）。结论:自凝刀子宫内膜射频消融术对围绝经期功能失调性出血疗效显著,恢复快、安全性高,对患者的内分泌激素水平无明显影响,值得临床推广应用。     

围绝经期抑郁与性激素的关系

围绝经期抑郁是一种首次发生于围绝经期的情感障碍性疾病 ,表现为焦虑、烦躁和压抑。近几年越来越多的学者开始重视围绝经期抑郁 ,已有的研究认为绝经前后体内性激素的变化与这种抑郁的发生有一定的相关性。现有的研究表明性激素对脑功能有显著的调节作用 ,而且性激素的变化和神经递质相互作用 ,也与围绝经期及绝经后抑郁的发生相关     

滋水清肝饮对围绝经期抑郁模型大鼠下丘脑CRH mRNA及5-HT含量的影响

目的:观察滋水清肝饮对围绝经期抑郁模型大鼠下丘脑促肾上腺皮质激素释放激信使核糖核酸(CRH mRNA)表达及5-羟色胺(5-HT)含量的影响。方法:将实验大鼠随机分组,分别在末次给药或给生理盐水24h后,颈椎脱臼法处死大鼠,冰盒上迅速分离下丘脑,采用逆转录-聚合酶联反应(RT-PCR)检测下丘脑CRH mRNA表达,高效液相色谱-电化学检测器法测定下丘脑5-HT含量。结果:各给药组大鼠CRH mRNA表达均升高,并与对照组比较有极显著性差异(P0.01);雌二醇组与模型组比较无显著性差异(P0.05),但与中药组比较有显著性差异(P0.05);中药组、雌二醇加百忧解组与模型组比较有显著性差异(P0.05)。模型组大鼠5-HT水平降低并与对照组比较有极显著性差异(P0.01);中药组大鼠5-HT水平升高,但与对照组比较无显著性差异(P0.05)。结论:模型大鼠下丘脑中CRH mRNA表达升高、5-HT降低。滋水清肝饮通过降调CRH mRNA转录水平可能影响下丘脑中5-HT能神经元的分泌和代谢,升高脑内5-HT含量,从而防止围绝经期抑郁症的发生。     

Gonadal hormone levels and platelet tryptophan and serotonin concentrations in perimenopausal women with or without depressive symptoms

Introduction: The etiology of depressive symptoms associated with the transition to menopause is still unknown; hormonal changes, serotonergic system or insomnia, could be a trigger to depressive symptomatology. The aim of the present study was to evaluate gonadal hormonal levels, platelet serotonin concentrations and platelet tryptophan concentrations in a group of depressed perimenopausal women and their healthy counterparts.

Methods: A total of 63 perimenopausal women between 45 and 55 years old were evaluated; of these, 44 were depressed patients, and 19 were perimenopausal women without depression. The instruments that were applied included the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HDRS) and the Green Climacteric Scale (GCS); gonadal hormone levels and platelet tryptophan and serotonin concentrations were measured in all participants. Differences in hormonal levels and tryptophan and serotonin concentrations were evaluated with respect to specific symptoms, such as insomnia, hot flashes, nervousness, depressed mood and loss of interest.

Results: No differences between groups were observed with respect to hormonal levels and tryptophan and serotonin concentrations; mean sleep hours and insomnia were significantly correlated with platelet tryptophan concentrations.

Conclusions: In this sample, all symptoms of depression could not be explained by platelet tryptophan and serotonin concentrations and hormonal levels; differences were observed only when we evaluated insomnia and hot flashes.     

齐墩果酸片对于围绝经期综合征免疫功能的改善作用研究

目的探讨齐墩果酸片对于女性围绝经期综合征免疫功能的改善作用。方法将40例围绝经期综合征患者随机分为2组,治疗组20例给予齐墩果酸片40 mg,3次/d口服;对照组20例给予尼尔雌醇1 mg,1次/周口服,第3个月第16天予安宫黄体酮,8 mg 1次/d口服,共服2周。2组均连续服用3个月为1个疗程。用ELISA法检测血清IL-2、IFN-γ、雌激素受体(ER)水平,用流式细胞仪检测外周血T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平。结果围绝经期妇女服用齐墩果酸片3个月后,CD4+、CD4+/CD8+明显增加,血清中IL-2、IFN-γ、ER上升,免疫功能增强。结论齐墩果酸片对于女性围绝经期综合征的免疫功能有明显改善作用,效果弱于尼尔雌醇。     

Impact of literacy on contraceptive practice in Indian perimenopausal women

Objectives

To study the contraceptive practices in perimenopausal women and to compare them between general population and staff nurses.

Methods

A questionnaire based study was done on 250 perimenopausal women (100 staff nurses and 150 women from general population) to evaluate the impact of literacy on the contraceptive choices among these women.

Results

Mean parity of the general population was more (3.2) as compared to the staff nurses (2.12) and this difference was statistically significant (p<0.001). Effect of literacy on reducing the parity was statistically significant (p=0.001) and was inversely related to it. Use of barrier method was more common in staff nurses as compared to general population (p<0.001). None of the women in either group were using oral contraceptive pills. Awareness about emergency contraception was more in staff nurses as compared to general population (p<0.001).

Conclusion

Intellectual status and literacy level has a definite role in using temporary methods of contraception more effectively. There is a need for creating awareness about emergency contraception among women more so amongst the general population     

长期木兰拳练习对围绝经期妇女腰椎和股骨近端骨密度及骨代谢相关激素水平的影响

采用双能Ｘ线吸收法（ＤＥＸＡ）、放免测定法对５５名围绝经期妇女进行测试,探讨围绝经期妇女长期进行木兰拳练习对骨密度及骨代谢激素的影响。结果表明,长期进行木兰拳练习的围绝经期妇女的骨密度与久坐工作者相比较;腰椎（Ｌ２－Ｌ４）、股骨颈（ＦＮ）、股骨近端（ＦＴＲＯ）和ＷＡＲＤＳ区（ＦＷＴ）的骨密度有显著性差异（Ｐ＜０．０５;骨代谢相关激素仅甲状旁腺素（ＰＴＨ）有显著性差异（Ｐ＜０．０５＝;同时发现,运动在围绝经期不同阶段的介入对骨密度亦有不同程度的影响。     

预防性输卵管切除术对卵巢功能的影响及其对盆腔疾病的预防作用

目的：探讨围绝经期女性因子宫良性疾病行开腹全子宫切除术同时预防性切除双侧输卵管对卵巢功能的影响以及对盆腔疾病（卵巢恶性肿瘤、卵巢良性肿瘤和盆腔炎性疾病等）的预防作用。方法：选择因子宫良性疾病行开腹全子宫切除术的患者100例,其中仅行全子宫切除术者50例作为对照组,行全子宫切除术同时行预防性双侧输卵管切除术者50例作为预防组。比较2组患者手术时间、术中出血量、排气时间和住院时间;比较术前及术后6个月、术后1年患者的卵巢基础窦卵泡数目和血清雌二醇（E2）、卵泡刺激素（FSH）及黄体生成素（LH）水平以及围绝经期综合征的发生率,随访患者术后盆腔疾病的发生率。结果：2组患者手术时间、术中出血量、排气时间及住院时间比较差异无统计学意义（P>0.05）;与术前比较,2组患者术后6个月和术后1年卵巢基础窦卵泡数目减少,E2水平降低,FSH和LH水平升高（P<0.01）;但组间卵巢基础窦卵泡数目和E2、FSH及LH水平比较差异无统计学意义（P>0.05）。2组患者术后围绝经期综合征发生率比较差异无统计学意义（P>0.05）。2组患者术后6个月、术后1年卵巢恶性肿瘤和卵巢良性肿瘤发病率比较差异无统计学意义（P>0.05）;对照组患者术后盆腔炎性疾病发病率明显高于预防组（P<0.05）。对照组有2例患者术后确诊为输卵管癌,预防组有2例患者输卵管病理回报见不典型细胞。结论：切除子宫同时行预防性输卵管切除术对患者卵巢功能未见明显影响,且能够有效降低盆腔良、恶性疾病及盆腔炎性疾病的发病率。     

围绝经期合并乳腺良性增生性疾病患者全程化药学服务模式构建与实践

目的:建立围绝经期合并乳腺良性增生性疾病患者的全程化药学服务模式,并评价激素补充治疗(hormone replace-ment therapy,HRT)用于这类特殊患者的有效性和安全性.方法:介绍某院更年期联合门诊服务于围绝经期合并乳腺良性增生性疾病患者的工作模式、团队构建和药师职责.统计分析142例乳腺良性增生性疾病...