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无排卵功能失调性子宫出血的研究进展
【作者】 何晓燕；
【导师】 卓毅；
【作者基本信息】 成都中医药大学 ， 中医妇科学， 2007， 硕士
【副题名】附：无排卵性功血中医药治疗性研究文献系统评价
【摘要】 功能失调性子宫出血,简称功血,是妇科常见病、多发病、疑难重病,功血可分为无排卵性和排卵性两类,其中无排卵功血约占85%。根据其临床症状,功血类属于祖国医学崩漏范畴。本文研究对象为无排卵性功血,祖国医学认为本病病机为:脏腑亏虚、冲任不固、不能制约经血。治疗方法包括辨证论治、中西医结合治疗、针灸治疗及分期治疗等。本病的西医学病理生理较复杂,发病机制至今尚未完全阐明,至今已在下丘脑—垂体—卵巢轴、性激素分泌、受体水平及子宫内膜局部环境改变的研究上取得了一定的成果。治疗包括药物、物理及手术治疗,药物治疗要求止血后进一步调周治疗,手术及物理治疗着重止血和防止内膜癌变。本文通过追朔近10年研究本病的中、西医文献资料,综述本病的中西医研究进展,并总结导师对本病的认识及临床治疗方法和疗效。本文另附无排卵性功血中医药治疗性研究文献系统评价,本统评价的目的在以循证医学、系统分析的方法,对中医药的临床疗效进行系统评价。本文检索国内发表的、研究中医药治疗无排卵性功血临床疗效的对照文献,收录在中国期刊网全文数据库和中文科技期刊网全文数据库,1996-2006年发表的文献,对文章的内容提示有无排卵型功血的临床研究报导,文章中的分组法中出现“随机”或“对照组”的字样,组间均衡性较好,具有对比性,研究中有一定含量的样本作了统计分析。根据临床流行病学/DME原则和方法,制定《无排卵性功血中医药治疗性文献系统评价表》,评价其质量。在此基础上利用Revman进行Meta分析。结论:可以初步认为,中医药治疗无排卵性功血的疗效佳。讨论:应进行严格的、多中心的随机双盲对照试验,以提供更具有说服力的证据。因本文纳入研究的文献数量少且质量不高,因此其论证强度较弱,尚需更多高质量研究以增加论证强度。
【Abstract】 Dysfunctional uterine bleeding(DUB),is a commonly encountered and severe disease in department of gynecology,can be divided into two types—non-ovulation and ovulation,without ovulation dysfunctional uterine bleeding accounts for 85%.According to the clinical symptoms,it belongs to metrorrhagia and metrostaxis. The study object of the paper is anovulatory dysfunctional uterine bleeding.In TCM,its pathogenesis usually dues to impairment of Chong and Ren channels which can not restrain menstruation and malfunction of Zang Fu Organs.Its therapeutic methods include treatment based on categorical identification、combined treatment of TCM and western medicine、acupuncture、phased treatment and so on.In western medicine,pathogenesis is so complicated that its mechanism is still unclear,but certern studies have reached,for example,hypothalamus-pituitary-ovary、hormone secretion、the levels of receptor、microenviroment of uterus.treating including:drug treatment、physiotherapy、operation.Drugtreatment include hemostasisand adjustment of the menstrual cycle,while operationatld physiotherapy focus on hemostasis and arresting cancerization of endangium.This paper provides a comprcheasion report on the accomplishment of TCM and western medicine on treating anowlatory dysfunctional uterine bleeding in last 10 years at home ad abroad, gives the comprehension of its mechanism and clinical experience of Professor。Another part of this article is systematic review of Chinese Therapies for anovulatory dysfunctional uterine bleeding.The method and result of the Evidence Based Medicine and systermatic analysis has been admitted and thought highly of by the international-medicine and the medical-decision department day by day.To utilize the Evidence-based medicine and the method of systematic analysis.can lead the Chinese Traditional to the world,to the modern.The purpose of the article is to use the systematic reviews Meta to evaluate the clinical effect of the TCM that it helps the Anovulatory bleeding.The Methods:The matched-control literatures are those published in the civil.To investigate the clinical effect of TCM that it helps the Anovulatory bleeding.Fingding CNKI WEB and CQVIP,during 1996-2006 years. Inclusion criteria:(1)The corrent of the article hints the report of the clinical investigation of the anovulatory bleeding.(2) The grouping of the article appears the words of "random" and"control group".It has the good balance between groups and comparance.The article should do statistic analysis to some samples.Based on the principle and the method of DME,formulat the Systematic Review Table of the treatment article of TCM to the anovulatory bleeding.Evaluating the quality.Then utilize the RevMan to procee Meta analysis.Conclusion:We can regard initially that the effect of TCM treating Anovulatory bleeding is better.Discussion:we should procee strict,multicentric randomized double blind control trail,to provide more reasonable proof.The quantity of inclusion is low,and the quality is not high.So the demonstration intensity is weak.We need much more high quality trail to add the demonstration intensity.