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全生妇科十讲6: 功能性子宫出血(10/19/2011)

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全生妇科十讲6: 功能性子宫出血(10/19/2011)

功能性子宫出血(dysfunctionaluterinebleeding,DUB),是一种常见的妇科疾病,据调查,90%以上的青春期女孩和女青年有不同程度的功能性子宫出血。凡月经不正常、生殖器官又没有器质性病变者,称为功能性子宫出血,简称功血,主要是由于神经系统和内分泌系统功能失调而引起。表现为月经周期不规律、经量过多、经期延长或不规则出血。根据排卵与否,通常将功血分为无排卵型及排卵型两大类,前者最为多见,约占80~90%,主要发生在青春期及更年期,后者多见于生育期妇女。

功能性子宫出血的常见诱因为精神过度紧张,环境和气候的变化,营养不良,劳累等,影响大脑皮层的神经介质干扰下丘脑–垂体–卵巢之间的互相调节和制约的机制,使失去正常规律,卵巢功能失调,性激素分泌量失常,影响子宫内膜周期变化而导致月经紊乱。
 
功能性子宫出血一般分三种类型:青春期功能性子宫出血:月经初潮时,下丘脑—垂体—卵巢轴正处在逐渐成熟的过程中,所以月经初潮两年内,月经周期不规则比较正常,一般能自行调整恢复。育龄期功能性子宫出血:多属于排卵型,常发生于产后或流产后。由于雌激素水平高,抑制下丘脑的分泌功能,垂体促性腺激素不足,影响卵泡的发育而无排卵或有排卵,而黄体发育不健。一般来说,育龄妇女的性腺轴应该处于稳定状态,发生异常的子宫出血多数是器质性病变,如炎症、赘肉、子宫肌瘤、子宫内膜异位等。更年期功能性子宫出血:在无排卵型功能性子宫出血患者中,更年期功能性子宫出血比较多见,但这个年龄的器质性病变也比较多。

功能性子宫出血主要表现为子宫出血和贫血。不规则子宫出血,多发生于青春期和更年期的妇女,其出血特点是月经周期紊乱,经期延长,血量增多,流血时间、出血量及间隔时间都不规律,往往短时间的闭经后发生子宫出血;月经间期出血,见于两次月经期中间出现子宫出血,流血量少;绝经期后子宫出血,出血量少,点滴而行。流血量多或时间持久,可致贫血症状,而贫血又致凝血功能障碍,进一步导致子宫出血,两者恶性循环,常导致疾病进一步加重。常伴有神疲乏力,心悸,面色苍白,爪甲无华,舌质淡等全身虚弱症状。
 
中医把功能性子宫出血归为“崩漏”、“月经不调”范畴。崩漏是指非经期阴道大量出血,或持续淋漓不断出血,前者称之崩,后者称之漏。崩与漏两者之间互可转化。辨证应依据出血的量、色、质及伴随症而辨其属虚、届热、属瘀。虚者多属脾气虚弱,肾气不固,阳气衰微,气血两虚,热者多属阴虚有热,或湿热壅阻;瘀者多属气滞血瘀或寒凝血瘀或损伤致瘀。
 
在中医理论指导下,采用塞流,澄源、复旧三法,治疗功能性子宫出血,疗效甚佳。遵循“急则治其标,缓则治其本”的原则,采用针灸治疗功能性子宫出血,简便易行,安全效佳。主穴取气海,隐白,三阴交。根据辩证,加以配穴。
 
 另外,对于功能性子宫出血患者,注意加强营养,纠正贫血,血期间应避免过劳或剧烈活动,保证充分休息,提高对月经病的认识,树立可以治愈的信心。几首小方,对功能性子宫出血有帮助。 1.桂元肉,大枣.莲肉各50g,糯米适量煮成粥,治心脾两虚功血。2. 艾叶蛋,去壳鸡蛋加艾叶煎水服,每日1次,可加强黄体功能。3. 乌梅红糖汤:乌梅15克,红糖30克—50克。将乌梅、红糖一起人煲,加水1碗半,煎剩至大半碗,去渣温服。具有补血止血、美肤悦颜功效。适用于妇女月经过多或功能性子宫出血症。
 
下期敬请关注全生妇科十讲7: 子宫内膜异位. 更多全生讲中医, 敬请访问卢全生中西医结合博士的网站www.wholelifeherb.com,或直接拨打中文热线电话301-340-7682,301-919-9898约诊. 全生中医针灸医疗中心地址:  416 Hungerford Dr, Suite 215, Rockville, MD 20850. 或 9801 Georgia Ave, Suite 337, Silver Spring, MD 20902
 

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