251.8 41 岁多次早产史孕妇中医安胎之病例报告
TJ TCM.25(1) : 99-112, 2022
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41 岁多次早产史孕妇中医安胎之病例报告
Combined Treatment of Chinese Medicine
and Western Medicine in Pregnant Women with Preterm Labor: A Case Report
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黄家莹1 陈光伟1 瞿瑞莹1*
1 马偕纪念医院中医部，台北，台湾
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【摘要】
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41 岁女性，过去曾有四次早产史G6P4A1（AA），前四胎皆住院完全卧床安胎分别至34、35、29、34 周自然生产。此次於怀孕18 周开始有腹部下坠感。口服安胎药物Ritodrine 下腹下坠紧绷感仍明显并增加，於怀孕18+1 周至本院急诊就医，诊断早产收缩（preterm contraction），於2018/6/10（GA：18+1 周）收入院安胎。
安胎住院前两个月完全卧床， 过程中使用Ritodrine、Nifedipine、Atosiban、Indomethacin 等安胎药物，药物使用剂量与频率提高後，仍持续感觉下腹下坠感与下腹紧绷收缩感，并开始出现喘、心悸、心跳上升（HR：100-110 次/ 分）等现象，於2018/8/16（GA：27+5 周）首次会诊中医。
经诊察，诊断证型以脾肾气虚为本，以气郁化热为标。治则为补脾益肾、理气清热和中。经中西合并治疗後，宫缩减缓，西药安胎药物剂量逐步下调，并於怀孕31 周时可以下床自由活动，安胎针剂改为口服剂型，於怀孕34 周出院，在怀孕36+1 周自然产下一3352 克健康男婴。
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【关键词】安胎、中西医结合治疗、先兆早产、胎漏
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Chia-Ying Huang1Jui-Ying Chu1*Kuan-Wei Chen1
1Department of Chinese Medicine of MacKay Memorial Hospital, Taipei, Taiwan
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【Summary】
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A 41-year-old pregnant woman with history of preterm delivery consulting Chinese Medical Department for frequent uterine contraction. Pressure sensation in the pelvic and irregular contraction without cervical dilation were found in the gestational age of 18th week, clinical diagnosis was preterm contraction thus the patient was hospitalized for tocolysis.
After 2-month administration of tocolytic agents (Ritodrine, Nifedipine, Atosiban, Indomethacin) and total bed rest, the contraction persisted accompanying with signs of palpitation, tachycardia, shortness of breath, flushing, and diaphoresis. Chinese medical doctor was consulted at the gestational age of 27+5th week.
After receiving Chinese medicine and western medicine treatment together, the frequency of contraction decreased, dose of tocolytic drug was tapered down and total bed rest was no longer needed. Patient was discharged at the gestational age of 34th week and delivered a healthy 3352g baby. This report aims to provide an effective clinical case for the treatment of preterm labor for Chinese medical practitioners.
【Keywords】Preterm Labor; Tocolysis; Combination of Chinese and Western Medicine
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