周霞

【摘要】 目的 對比左炔諾孕酮宮內(nèi)緩釋系統(tǒng)（LNG-IUS）與安宮黃體酮治療圍絕經(jīng)期異常子宮出血（AUB）的臨床療效。方法 104例圍絕經(jīng)期異常子宮出血患者， 按照隨機數(shù)字表法分為觀察組和對照組， 每組52例。對照組采用安宮黃體酮治療， 觀察組采用左炔諾孕酮宮內(nèi)緩釋系統(tǒng)治療。比較兩組患者治療前后月經(jīng)量及經(jīng)期時間;治療前后血紅蛋白（Hb）水平和子宮內(nèi)膜厚度;臨床治療效果;不良反應(yīng)發(fā)生情況。結(jié)果 治療后， 兩組患者月經(jīng)量及經(jīng)期時間均較治療前顯著減少， 且觀察組均明顯少于對照組， 差異均具有統(tǒng)計學(xué)意義（P<0.05）。治療后， 兩組患者Hb水平均較治療前顯著升高， 且觀察組明顯高于對照組， 差異均具有統(tǒng)計學(xué)意義（P<0.05）;治療后， 兩組患者子宮內(nèi)膜厚度值均較治療前明顯降低， 且觀察組子宮內(nèi)膜厚度值明顯低于對照組， 差異均具有統(tǒng)計學(xué)意義（P<0.05）。觀察組患者臨床治療總有效率為96.15%， 明顯高于對照組的82.69%， 差異具有統(tǒng)計學(xué)意義（P<0.05）。治療前后兩組患者肝腎功能檢查均無明顯異常。治療期間的不良反應(yīng)主要為陰道點滴出血、惡心頭暈及乳房脹痛， 癥狀均較輕微， 患者可耐受， 停藥后均自行緩解。觀察組患者不良反應(yīng)發(fā)生率為13.46%， 與對照組的15.38%比較差異無統(tǒng)計學(xué)意義（P>0.05）。結(jié)論 利用左炔諾孕酮宮內(nèi)緩釋系統(tǒng)治療圍絕經(jīng)期異常子宮出血的效果優(yōu)于安宮黃體酮， 臨床療效確切， 用藥安全， 無明顯不良反應(yīng)， 值得臨床推廣。

【關(guān)鍵詞】 左炔諾孕酮宮內(nèi)緩釋系統(tǒng);安宮黃體酮;圍絕經(jīng)期;異常子宮出血;療效

DOI：10.14163/j.cnki.11-5547/r.2019.23.004

Comparison of the efficacy of levonorgestrel releasing intrauterine system and medroxyprogesterone acetate in the treatment of abnormal uterine bleeding in perimenopausal period? ?ZHOU Xia. Shandong Linyi Linshu County Maternal and Child Health Hospital， Linyi 276700， China

【Abstract】 Objective? ?To compare the clinical efficacy of levonorgestrel releasing intrauterine system （LNG-IUS） and medroxyprogesterone acetate in the treatment of abnormal uterine bleeding （AUB） in perimenopausal period. Methods? ?A total of 104 patients with abnormal uterine bleeding in perimenopausal period were divided by random number table method into observation group and control group， with 52 cases in each group. The control group was treated with medroxyprogesterone acetate， and the observation group was treated with levonorgestrel releasing intrauterine system. Comparison was made on menstrual blood volume and duration of menstruation， hemoglobin （Hb） level and endometrial thickness before and after treatment， clinical treatment effect and occurrence of adverse reactions between the two groups. Results? ?After treatment， both groups had significantly less menstrual blood volume and shorter duration of menstruation than those before treatment， and the observation group was obviously less than the control group. Their difference was statistically significant （P<0.05）. After treatment， both groups had significantly higher Hb than that before treatment， and the observation group was obviously higher than the control group. Their difference was statistically significant （P<0.05）. After treatment， both groups had obviously thinner endometrial thickness than those before treatment， and the observation group had obviously thinner endometrial thickness than the control group. Their difference was statistically significant （P<0.05）. The observation group had obviously higher total effective rate of clinical treatment as 96.15% than 82.69% in the control group， and the difference was statistically significant （P<0.05）. There was no significant abnormality in liver and kidney function before and after treatment in both groups. The main adverse reactions during treatment were slight bleeding of vagina， nausea and dizziness， breast swelling and pain. The symptoms were mild， tolerable and self-relief after withdrawal. The observation group had no statistically significant difference in incidence of adverse reactions as 13.46%， compared with 15.38% in the control group （P>0.05）. Conclusion? ?Levonorgestrel intrauterine sustained release system shows better effect than medroxyprogesterone acetate in treating abnormal uterine bleeding. The clinical curative effect is definite， the medication is safe， and there is no obvious adverse reaction. It is worthy of clinical promotion.