曲秀芬教授治疗高龄女性复发性流产经验

Professor Qu Xiufen Experiences for Treatment of Recurrent Spontaneous Abortion in Advanced Maternal Age Women

摘要: 复发性流产是育龄期女性临床常见病及流产类疑难病，尤其对于高龄女性因其病因复杂，治疗过程相对困难，更应重视。复发性流产的发生与多种因素有关，但其中有50%原因不明。许多研究显示，自然流产的再发生风险与自然流产的次数有关,高龄亦是复发流产的高危因素。有过1次人工流产的女性发生RSA的风险是没有人工流产的3.28倍。年龄≥40岁的女性发生RSA的风险是年龄<20岁的女性的4.06倍。高龄女性多有手术流产病史及卵巢功能相对较差，故自然流产的风险又相对更高，并且自“二孩”政策开放以来，有意愿生育二孩的女性多，因此高龄女性的围生期治疗显得尤为重要。曲秀芬教授认为，高龄女性复发性流产的病机以肾虚为本，多以肾阳虚为著，兼有肝郁、脾虚、血瘀等。治疗强调标本兼顾，主张“治未病”的思想，孕前调理，培育其损；孕期保胎，固护胎元，且重视高龄女性的心理疏导及生活方式指导，发挥中医治疗此病的优势，既能满足患者的生育要求，又可为国家的生育政策做出突出贡献。

Abstract: Recurrent spontaneous abortion (RSA), a difficult and complicated disease, is a common disease of the child-bearing age women. Especially for advanced maternal age women, the etiology is complex and difficult to treat, so more attention should be paid. RSA is associated with a variety of factors, but fifty percent of these are unknown. Many studies show that the risk of RSA is related to the number of spontaneous abortions; advanced age is also a high risk factor for RSA. The risk of RSA of women with at least once abortion was 3.28 time of women without abortion. The risk of RSA in women at order age (≥40 years old) was 4.062 time of that younger women (<20 years old). Most advanced age women have a history of surgical abortion, and the function of ovarian is relatively poor, so the risk of RSA is much higher. Since the implement of “the second child” policy, women who wish to have the second child are almost older than 35 years old, so prenatal treatment is particularity important for advanced women. Professor Qu concludes that the etiology and pathogenesis of the disease is the deficiency of the kidney; deficiency of kidney-yang is the main factor, and liver-qi stagnation, spleen deficiency, blood stasis and so on. Treatment emphasizes both the surface and essence, symptomatic treatment should be applied before pregnancy and after pregnant. We pay attention to psychological counseling and lifestyle guidance, give full play to the advantages of traditional Chinese medicine treatment to meet the fertility requirements of patients and make contributions to the national fertility policy.