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目的探讨微生物制剂(阴道乳杆菌胶囊)对产后6周妇女特异性阴道炎(细菌性阴道病、滴虫性阴道炎、外阴阴道念珠菌病)的防治作用。方法采用前瞻性研究方法。自2009年6月至2011年8月先后收集895例产后6周特异性阴道炎妇女,包括细菌性阴道病535例、外阴阴道念珠菌病339例和滴虫性阴道炎21例,随机分成三组,第一组(n=200)阴道局部用乳杆菌胶囊(定君生)250 mg/d,连用10 d;第二组(n=200)阴道局部用抗菌药(细菌性阴道病或滴虫性阴道炎:甲硝唑栓500 mg/d,外阴阴道念珠菌病:克霉唑栓150 mg/d,连用10 d);第三组(n=200)阴道局部用抗菌药+乳杆菌胶囊(细菌性阴道病或滴虫性阴道炎:甲硝唑栓500 mg/d+定君生250 mg/d,外阴阴道念珠菌病:克霉唑栓150 mg/d+定君生250mg/d,连用10 d),三组均于停药1周后复查阴道分泌物以了解疗效,以及产后3、6、9、12个月分别复查阴道分泌物,以了解三组产后1年内阴道pH、乳杆菌数量变化情况及阴道炎复发率情况。结果 600例产后6周特异性阴道炎妇女中,单用定君生治疗组总有效率为76.5%;用甲硝唑栓或克霉唑栓治疗组总有效率为77.5%;两组总疗效比较差异无统计学意义(P>0.05)。用抗菌药(甲硝唑栓或克霉唑栓)+定君生治疗组总有效率为95.0%,与前两组比较差异有统计学意义(P<0.05)。应用定君生治疗两组1年内阴道pH明显降低,阴道乳酸杆菌数量明显增多,以+++~++++比例为主,且追踪1年阴道炎的发生率均明显降低,与只用抗生素治疗组相比差异有统计学意义(P<0.05)。结论阴道乳杆菌胶囊(定君生)是治疗特异性阴道炎的有效药物,与传统抗生素相比疗效差异无统计学意义,且定君生联合抗生素治疗特异性阴道炎,疗效更为显著,这不失为一个新的治疗途径。产后6周妇女特异性阴道炎选用微生态制剂(阴道乳杆菌胶囊),能防止因使用抗生素引发的耐药性、二重感染、过敏反应以及对机体的毒副作用等弊端,提高特异性阴道炎的治愈率,减少复发和再生率,有利于恢复产后妇女阴道微生态平衡,从而起到防病治病的目的,值得临床推广。
Objective To investigate the prevention and treatment of vaginal candidiasis (bacterial vaginosis, trichomonas vaginitis, vulvovaginal candidiasis) by microbiological agents (Lactobacillus vaginalis capsule) at 6 weeks postpartum. Methods Using prospective research methods. From June 2009 to August 2011, 895 postpartum vaginitis women were collected, including 535 cases of bacterial vaginosis, 339 cases of vulvovaginal candidiasis and 21 cases of trichomonas vaginitis. The patients were randomly divided into three groups The first group (n = 200) of vaginal Lactobacillus capsules (Ding Jun Sheng) 250 mg / d, once every 10 d; the second group (n = 200) vaginal topical antibacterials (bacterial vaginosis or drops Vomiting vaginitis: metronidazole suppository 500 mg / d, vulvovaginal candidiasis: clotrimazole suppository 150 mg / d, once every 10 d); the third group (n = 200) vaginal topical antibacterial + lactobacilli Capsules (bacterial vaginosis or trichomonas vaginitis: metronidazole suppository 500 mg / d + Ding Junsheng 250 mg / d, vulvovaginal candidiasis: clotrimazole suppository 150 mg / d + Ding Junsheng 250 mg / d, Used for 10 days). The three groups were examined vaginal discharge after 1 week withdrawal to understand the curative effect, and vaginal discharge were reviewed at 3, 6, 9 and 12 months postpartum respectively to understand the vaginal pH, Changes in the number of bacilli and vaginitis recurrence rate. Results In 600 women with specific vaginitis at 6 weeks postpartum, the total effective rate was 76.5% in the group treated with Ding Jun Sheng alone, and the total effective rate was 77.5% in the group treated with metronidazole suppository or clotrimazole. The total effective rate The difference was not statistically significant (P> 0.05). The total effective rate was 95.0% with antimicrobial agents (metronidazole suppository or clotrimazole suppository) + Ding Jun Sheng treatment group, with statistical significance (P <0.05) compared with the former two groups. The application of Dingjunsheng treatment of vaginal pH was significantly reduced in both groups within 1 year, the number of vaginal Lactobacilli increased significantly to +++ ~ ++++ ratio, and follow-up 1 year incidence of vaginitis were significantly reduced, and only The antibiotic treatment group compared with the difference was statistically significant (P <0.05). Conclusions Lactobacillus vaginalis capsule (Ding Junsheng) is an effective drug for the treatment of specific vaginitis. Compared with traditional antibiotics, there is no significant difference in curative effect between the two groups. And the effect of Ding Jun students combined with antibiotics in treating specific vaginitis is more obvious After all, a new treatment. 6 weeks postpartum women-specific vaginitis use probiotics (Lactobacillus vaginalis capsule), to prevent the use of antibiotic-induced resistance, double infection, allergic reactions and the side effects of the body and other malpractice, improve specific vaginitis Cure rate, reduce recurrence and regeneration rate, is conducive to the recovery of postpartum women vaginal microecological balance, which play a preventive and therapeutic purposes, is worth clinical promotion.