| Objective To study and analyze different clinical intervention measures of LNG-IUS adverse reactions,to evaluate its clinical value,to explore some safer and feasible preventive and curative measures,to obtain the clinical data of different treatment methods and to provide reference for clinical treatment,Expect to improve the utilization rate and the renewal rate of Mirena and ensure the quality of contraception and the treatment effect on the disease.Research methods 1.Experimental grouping According to the inclusion criteria,we retrospectively selected 600 patients with persistent vaginal spotting,menopause,and ring shedding after gynecological placement of the Man Yue Lok in our hospital from April 2012 to April 2017,according to the type of adverse reactions.Study groups: vaginal bleeding group(325),menopausal group(130),and annulation group(145).2.Observation indicators 2.1 Observed indicators of vaginal bleeding group The vaginal bleeding group was divided into the traditional Chinese medicine group according to different treatment plans(Qigong Zhixue Granules,Gynecological Zhixueling Tablets,Yunnan Baiyao Capsules,one random drug orally)(n=108),contraceptive treatment group(Mai Fulong Tablets,You Siming tablets and You Siyue tablets were randomized to oral administration of one(n=100)and control(n=117).The above groups took the drug from the first 1-3 days after the release of the ring,and stopped after the blood stopped.The clinical follow-up of the above three groups was completed according to the experimental requirements.The comparison of bleeding volume,bleeding duration,and endometrial thickness of the three groups of different treatment programs at the first month,the third month,and the sixth month was performed.analysis.2.2 Menopausal group observation index In the case of excluding pregnancy after releasing the ring,menstruation is judged as menopause when the menstrual cycle naturally stops for more than 3 cycles.The menopause group was divided into experimental group(n=68)and control group(n=62)according to whether or not treatment was adopted.In the experimental group,the estradiol valerate tablets(1 mg/tablet/day)were administered in the original menstrual cycle after the release of the ring for 3 consecutive months;the control group did not take any treatment measures in the case of excluding pregnancy.The endometrium thickness,hormone levels(estrogen,progesterone,follicle-stimulating hormone,and luteinizing hormone),menstrual re-tide status,and patient satisfaction were compared between the experimental group and the control group.2.3 Outliers Observations According to the colpotomography of the vagina,the distance between the lower edge of the ring and the inner mouth of the cervix was divided into three groups.The ring should be removed if the lower edge of the ring is detached from the outer cervical area.Group 1(n=48): the lower margin of the ring is 0-2cm from the internal cervical orifice.Group 2(n=52): the lower edge of the ring is 2-3cm from the inner mouth of the cervix.Group 3(n=45): the lower edge of the ring is greater than 3cm from the inner mouth of the cervix,but the lower edge of the ring is not detached from the outer cervical outlet.The above three groups were followed up and observed for 6 months after 3 to 7 days(during the period of asexual life)of menstruation in b-superconducting supraural ring reduction.The degree of dysmenorrhea,the amount of bleeding during menstruation and the duration of bleeding were compared in the first month,the third month and the sixth month after the operation.3.Methods of observation3.1 Continuous vaginal bleeding method A weighted method was used to calculate the amount of postoperative vaginal bleeding after the Mirena ring.The patient's daily toilet paper and sanitary pads were weighed by themselves and the values were recorded and collected by the testers for calculation.The calculation method was: increased weight/ 1.05 = amount of bleeding(ml).3.2 PBAC assessment of postoperative menstrual blood loss The pictorial blood loss assessment chart(PBAC)is used to estimate menstrual blood volume.The menstrual sanitary napkins used by the patients were collected by the experimental personnel and classified,scored,and filled in according to the menstrual blood loss map score.3.3 VSA method to assess dystonia in patients after Mirena reset The Visual Analogue Scale(VSA)scored the degree of pain of the dysmenorrhea after the resettlement of the Mirena ring by the observer.3.4 Overdetection of Endometrial Thickness Patients in the detached group were examined for endometrial thickness at the thickest part of the long-axis uterine section of the uterus using vaginal ultrasound at various time points after placement of Mirena.3.5 Determination of hormones in vivo The levels of various hormones in the body were determined by chemotherapeutic immunoassay for venous blood.3.6 Patient Satisfaction Rating System The patients in the menopausal group used the Mirena ring and told the patients to score the LNG-IUS according to the subjective feelings and objective effects after use,with a score of 15 points.After the processing of different plans,the scores were re-evaluated according to the above criteria.4.Statistical analysis The data was analyzed by SPSS 21.0.Measured data were expressed as meanąstandard deviation.The two groups of measurement data were compared using two independent sample t-tests.The test level was ?=0.05.Comparison between multiple groups was compared by one-way ANOVA.,test level ? = 0.05,P<0.05 that the difference was statistically significant.Results 1 Observation results of vaginal bleeding group 1.1 The amount of bleeding and duration of vaginal spotting in each drug group after placing the Mirena ring The vaginal spotting volume and duration of the contraceptives in the three treatment groups were significantly lower than those in the three treatment groups of traditional Chinese medicine(P<0.05).There was no statistically significant difference between the three drug groups in the amount of vaginal spotting and the number of consecutive days.Differences in learning(P>0.05).In the contraceptive treatment group,the amount of vaginal spotting in the Mafulong Tablets and Yousimei Tablets was lower than that in the Yousiyue Tablets(P<0.05),but there was no statistically significant difference between the three groups in the duration of the treatment(P >0.05).The above results show that timely application of contraceptives after surgery can effectively improve the vaginal bleeding induced by Mirena.1.2 Changes in monthly menstrual flow in each drug group after placement of Mirena The PBAC scores in the first,third and sixth months of the contraceptive treatment group were significantly lower than those in the Chinese medicine treatment group and the control group(P<0.05).The three treatment groups of the Chinese medicine were in the first month and the first There was no statistically significant difference in PBAC score between the three months and the sixth month(P>0.05).There was no significant difference in PBAC scores between the Chinese medicine treatment group and the contraceptive treatment group(P>0.05).See Figure 1 and Figure 2.The above results show that the timely use of traditional Chinese medicine hemostatic drugs or contraceptive treatment can significantly reduce the total vaginal bleeding in the late period of the Mirena ring placement,and in the long-term assessment of postoperative menstrual flow results,with the contraceptive Treatment is better than traditional Chinese medicine treatment.1.3 Menstrual changes in follow-up records of each drug group after placement of Mirena There was no significant statistical difference(P>0.05)in the duration of menstruation between the Chinese medicine treatment group,the contraceptive treatment group,and the control group between the first month,the third month,and the sixth month,and there was also contraception among the Chinese medicine treatment groups.There was no significant difference in the duration of vaginal bleeding between the first month,the third month,and the sixth month among the drug treatment groups(P>0.05).The above results indicate that the duration of menstrual period was not significantly reduced after the Mirena ring was treated with traditional Chinese medicine hemostatic drugs or contraceptives after the Mirena ring.1.4 Endometrial Thickness(ET)Recorded by Each Medication Group after Placement of Mirena There was no significant difference in endometrial thickness between the first month,the third month,and the sixth month between the Chinese medicine treatment group and the control group(P>0.05).The contraceptive treatment group was better than the control group and the Chinese medicine treatment group.The endometrial thickness was significantly reduced between the third month and the sixth month(P<0.05).The thickness of the endometrium measured at the sixth month in the Chinese medicine treatment group,the contraceptive treatment group,and the control group was significantly lower than that in the first and third months(P<0.05);the third and sixth months of the contraceptive treatment group were measured.The thickness of the endometrium was also lower than that measured in the first month(P<0.05).The above results show that the contraceptive treatment after the placement of the Mirena ring significantly affects the thickness of the endometrium,and the ring itself also inhibits membrane proliferation in the uterus.2 Menopausal group observation index results 2.1 Observation of Endometrial Thickness after Menopause Placement in Two Groups of Mirena Rings There was no significant difference in the endometrial thickness between the experimental group and the control group(P>0.05).However,the thickness of the endometrium in both the experimental group and the control group decreased significantly(P<0.05)three months and six months after the Mirena ring placement.The above results show that,with the extension of time,Mirena significantly reduced the thickness of the endometrium of the patient.Although there is an adverse effect of menopause,the thickness of the endometrium at each time period in the estradiol valerate treatment group is higher than the control.There was no significant statistical difference in the groups.2.2 Comparison of hormone levels in the two groups after menopause The estrogen level in the experimental group at the sixth month after Mirena was significantly higher than that of the control group(P<0.05).The levels of other hormones(progestin,follicle-stimulating hormone,and luteinizing hormone)were not statistically different at the third and sixth months after surgery(P>0.05).The above results demonstrated that the hormone levels in patients after the placement of Mirena rings remained at normal levels,and there was no statistically significant difference in the level of hormones between the estradiol valerate medication group and the control group,so on the other hand,This shows that adverse reactions induced by Menorrhagia did not affect the hormone levels in patients after surgery.2.3 Comparison of menstrual relapse in the two groups The number of recurrent surges and rehydration rate in the experimental group were significantly higher than those in the control group.The menstrual cycle was significantly lower than that in the control group(P<0.05),but the menstrual period after rehydration and menstrual period did not have significant differences.Significant statistical differences(P>0.05).The above results demonstrated that the estradiol valerate medication group significantly improved the menstrual rehydration rate and shortened the menstrual cycle after Mirena ring surgery.2.4 Comparison of Satisfaction of Patients in Two Groups Satisfaction of patients in the control group and experimental group was significantly higher than those in the control group at three months postoperatively and at six months postoperatively(P<0.05).Satisfaction of the three months and six months of the experimental group was higher than that of the control group.Significantly increased(P<0.05).The above results showed that the adverse reactions that occurred after 3 months of placing the Mirena ring in the patient's body increased the resistance and adverse experience of the Mirena,but the experimental group significantly improved the patient's menstrual characteristics and experience.Later,due to the bad mood brought by the menopause,the use rate and continuation rate of the Mirena ring were improved.3 Outlier observation results 3.1 Change in menstrual blood volume after reset of Mirena ring The PBAC scores of the three groups in the third and sixth months after the reduction of the Mirena ring were significantly lower than those in the first trimester(P<0.05).The third group was in the third group after the reset of the Mirena ring.The PBAC scores at one month,third month,and sixth month were significantly higher than the PBAC scores at the first,third,and sixth months after the release of the detached group 1 and 2(P<0.05).There was no significant difference in the PBAC scores measured between the de-cycling group 2 and the de-cycling group 1(P>0.05).The above results show that Mirena ring repairs can effectively reduce menstrual quantity caused by Mirena ring off too many questions,and from the womb mouth edge of Mirena ring distance in 0 cm < d < 3 cm between the PBAC score reduction effect is superior to the edge of the ring from the womb mouth distance is greater than 3 cm group.3.2 Change in duration of menstrual bleeding after reset of Mirena ring Group 1 and group 2 had a significant decrease in menstrual duration in the third and sixth months after the restoration of the Mirena ring(P<0.05),and group 3 was the third after the reset of the Mirena ring.The menstrual duration of six months was significantly higher than that of the same period group 1 and group 2(P<0.05).The above results indicate that the reduction of the menstrual period caused by the withdrawal of the Mirena ring can effectively reduce the problem of the long menstrual period caused by the Mirena ring resetting,and from the womb mouth edge of the Mirena ring distance in 0 cm < d < 3 cm between menstrual bleeding duration after reset is superior to the edge of the ring from the womb mouth distance is greater than 3 cm group.3.3 Changes in the degree of dysmenorrhea in patients after reduction of Mirena ring The VSA scores of the three groups after 3 months and 6 months after the restoration of the Mirena ring were significantly lower than those in the first month after reset(P<0.05).The group 3 out-of-loop group was reset after the Mirena ring was reset.The third and sixth month VSA scores were significantly higher than the third and sixth month VSA scores after group 1 and 2 reset(P<0.05).The above results show that the Mirena ring reset can effectively improve the dysmenorrhea caused by the dislocation,and from the womb mouth edge of the Mirena ring distance in 0 cm < d < 3 cm between the VSA score reduction effect is superior to the edge of the ring from the womb mouth distance is greater than 3 cm group.Conclusion 1.The timely use of traditional Chinese medicine hemostatic drugs or contraceptives after the placement of the Mirena ring can significantly reduce the total amount of vaginal bleeding at the later stage.In terms of long-term assessment of bleeding volume,contraceptive treatment is superior to traditional Chinese medicine.The timely application of contraceptives after surgery can effectively improve the vaginal spotting induced by Mirena.2.The postmenopausal estradiol valerate medication group had no significant difference in the thickness of the endometrium and hormone levels in the postoperative period compared with the control group.However,the estradiol valerate medication group can maintain the menstrual characteristics and experience of the patient and significantly improve the postoperative negative emotions caused by the menopause,thereby improving the utilization rate and continuation rate of the Mirena.3.The reduction of the detachment group can effectively reduce the excessive menstrual flow and dysmenorrhea caused by the withdrawal of the Mirena ring;The reduction of the lower margin of the Mirena ring from the intrauterine orifice between 0~3cm was better than that of the lower margin of the Mirena ring from the intrauterine orifice. |
PDF Full Text Request