| 中文摘要 |
這位32歲的孕婦，曾有一次正常足月懷孕生產的經驗（G2P1A0），這次懷孕的最後一次月經為2008/01/02，在懷孕第21週（入院3週前）時，發現陰道少量出血，沒有伴隨腹痛，超音波檢查發現子宮頸縮短到約2-3cm，暫時服用安胎藥Ritodrine及止血藥transamin。兩週後（入院1週前）再度發現有陰道少量出血，伴隨腹痛，超音波檢查發現子宮頸縮短至1.3 cm，陰道檢查發現子宮頸擴張約1公分，臨床診斷為疑似子宮頸閉鎖不全。在2008/06/25（懷孕24+6週）住院接受子宮頸環紮術，並給予安胎針劑Ritodrine，故出現心悸、喘促、口乾、偶烘熱的症狀，心跳介於80至120 bpm之間，沒有感染現象，治療期間仍有頻繁不規則子宮收縮，且陰道仍有少量出血，為粘稠狀夾帶鮮紅血絲。在2008/06/29（懷孕25+3週）會診中醫，診察發現：舌黯紅，苔中根微白膩，邊尖少苔，有齒痕。舌下絡脈無異常；語音稍低微，說話久自覺少氣；子宮仍有收縮，收縮強度中等，每8~15分鐘一次，每次持續30秒，四肢膚溫，下肢無水腫。脈寸動甚、關弦細數帶促，尺弱。證型以腎氣虧虛、氣虛下陷、肝鬱氣滯、陰虛生熱動血為本，以心氣陰虛為標，治法使用補腎固沖任以安胎，益氣升提，疏肝理氣，滋陰涼血止血。經中、西醫結合治療後，陰道出血已無，宮縮轉為輕微，安胎針劑改為口服，並出院休養，持續服用中藥，於足月自然產下一健康男嬰。A 32-year-old pregnant woman with a smooth obstetric history (G2P1A0；lmp：2008/01/02) consulted Chinese Medical Department for frequent uterine contractions with vaginal bleeding for one week. Vaginal bleeding without abdominal pain was found in the gestational age of 21st week. The cervical length was about 2-3 cm. She received tocolysis drug and hemostatic agent. Vaginal bleeding with abdominal pain was noticed again 2 weeks later. The cervical length was about 1.3 cm. Vaginal dilatation about 1 cm was noted through vaginal examination. The suspect clinical diagnosis was cervical incompetence. Cervical cerclage was performed in the gestational age of 24+6th week. After receiving Ritodrine for tocolysis, she felt palpitation, dyspnea, thirsty, and hot flushing. The heart rate was between 80-120 beats per minute. There were no infection signs. During tocolysis, Ritodrine was reduced and changed to oral form once. Because uterus constriction progressed after walking, Ritodrine was changed back to intravenous form. She still had irregular uterine contractions. A small amount of vaginal bleeding persisted, and it was viscous with some fresh blood. Chinese medical doctor was consulted for tocolysis in the gestational age of 25+3th week. Tongue examination revealed：dark red tongue with mild white slimy fur in the central and root of tongue, less fur in the side and tip of tongue, tooth-print, and normal length and width of sublingual vessels. She had a weaker voice, and felt tired after talking. Her uterine contracted once every 8~15 minutes moderately, and each contraction last for 30 seconds. Stirred pulse at cun, stringlike-fine-racing pulse at guan, and forceless pulse at cubit were noticed. The skin of four limbs was warm. There was no leg edema. The pattern of root was kidney qi deficiency, insecurity of thoroughfare and conception vessels, qi sinking, liver depression and qi stagnation, and yin deficiency with internal heat stirring blood; the pattern of tip was heart qi and yin deficiency. The therapeutic method was reinforcing kidney, securing thoroughfare and conception vessels, tonifying and upraising qi, soothing liver and regulating qi, and nourishing yin and cooling the blood to stop bleeding. After combination of Chinese medicine and Modern medicine, vaginal bleeding disappeared and uterine contractions were milder. Therefore, Ritodrine was changed to oral form and the patient was discharged. She took Chinese herbs continuously at home. One healthy full-term male baby was normally spontaneous delivered. |
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