目的 探讨云南白药胶囊联合地屈孕酮治疗异常子宫出血的临床疗效。方法 选取2023年2月—2025年6月北京中医药大学房山医院收治的146例异常子宫出血患者的病例资料进行回顾性分析，按治疗方案不同分为对照组和治疗组，每组各73例。对照组口服地屈孕酮片，出血期初始剂量10 mg/次，1次/8 h，出血停止后逐渐减量，每3天减1/3剂量，维持剂量10 mg/次，1次/d，连服21 d为1个疗程。在对照组基础上，治疗组口服云南白药胶囊，出血期4粒/次，出血停止后调整为2粒/次，3次/d。两组均连续治疗42 d。比较两组临床疗效、出血控制情况，治疗前后子宫内膜厚度、月经失血图（PBAC）、症状自评量表（SCL-90）、SF-36健康调查简表（SF-36）及凝血酶原时间（PT）、国际标准化比率（INR）和血清雌二醇（E₂）水平。结果 治疗后，治疗组总有效率较对照组明显升高（94.52% vs 83.56%，P＜0.05）。治疗后，治疗组控制出血、完全止血和HGB复常的时间都短于对照组（P＜0.05）。治疗后，两组子宫内膜厚度和PBAC、SCL-90评分都降低，而SF-36评分都增加（P＜0.05），且治疗组评分都优于对照组（P＜0.05）。治疗后，两组PT、INR和血清E₂水平都下降（P＜0.05），且治疗组指标水平均低于对照组（P＜0.05）。结论 采用云南白药胶囊联合地屈孕酮治疗异常子宫出血能有效缩短出血控制时间及止血时间，快速纠正贫血，调控子宫内膜生长，改善凝血功能及激素水平，利于缓解患者心理压力、提升生活质量，且未增加不良反应风险。

Objective To explore the clinical efficacy of Yunnan Baiyao Capsules combined with dydrogesterone in treatment of abnormal uterine bleeding. Methods A retrospective analysis was performed on the clinical data of 146 patients with abnormal uterine bleeding admitted to Fangshan Hospital of Beijing University of Chinese Medicine from February 2023 to June 2025. According to different treatment regimens, the patients were divided into a control group and a treatment group, with 73 cases in each group. The control group was given oral dydrogesterone tablets: the initial dose was 10 mg per time, once every 8 hours during the bleeding period; after bleeding stopped, the dose was gradually reduced by 1/3 every 3 days, with a maintenance dose of 10 mg per time, once a day, and 21 consecutive days as one course of treatment. On the basis of the control group, the treatment group was additionally given oral Yunnan Baiyao Capsules: 4 capsules per time during the bleeding period, and adjusted to 2 capsules per time, 3 times a day after bleeding stopped. Both groups received continuous treatment for 42 days. Clinical efficacy, bleeding control, endometrial thickness, Pictorial Blood Loss Assessment Chart (PBAC) score, Symptom Checklist-90 (SCL-90) score, 36-Item Short-Form Health Survey (SF-36) score, prothrombin time (PT), international normalized ratio (INR), and serum estradiol (E2) level before and after treatment were compared between the two groups. Results After treatment, the total effective rate of the treatment group was significantly higher than that of the control group (94.52% vs 83.56%, P < 0.05). The time to control bleeding, complete hemostasis, and hemoglobin (HGB) normalization in the treatment group was shorter than that in the control group (P < 0.05). After treatment, the endometrial thickness, PBAC score, and SCL-90 score of both groups decreased, while the SF-36 score increased (P < 0.05), and the scores of the treatment group were better than those of the control group (P < 0.05). After treatment, the PT, INR, and serum E2 levels of both groups decreased (P < 0.05), and the indicators of the treatment group were lower than those of the control group (P < 0.05). Conclusion The combination of Yunnan Baiyao Capsules and dydrogesterone in the treatment of abnormal uterine bleeding can effectively shorten the time to control bleeding and hemostasis, quickly correct anemia, regulate endometrial growth, improve coagulation function and hormone levels, help relieve patients’ psychological pressure, and improve their quality of life without increasing the risk of adverse reactions.

R984

北京中医药大学新教师启动基金资助项目(2023-BUCMXJKY-035)