【目的】 评价桂枝汤内服联合半夏茯苓汤穴位贴敷治疗太阴证型妊娠恶阻（妊娠期恶心呕吐）的临床疗效。【方法】 将60例 太阴证型妊娠恶阻患者按 1∶1比例随机分为治疗组和对照组，每组各 30例。对照组给予半夏茯苓汤穴位贴敷（取穴：中脘、 双侧内关、双侧足三里、双侧阴陵泉），治疗组在对照组的基础上加用桂枝汤内服，共治疗 2周。观察 2组患者治疗前后孕 期呕吐和恶心专用量表（PUQE）评分、孕期妊娠恶心呕吐生活质量量表（NVPPQOL）评分和中医证候积分的变化情况，并对 2组患者治疗前PUQE评分的影响因素进行多元线性回归分析，同时比较2组患者的愈显率以及妊娠焦虑转阴率、尿酮体转 阴率。【结果】（1）疗效方面，治疗2周后，治疗组的愈显率为86.67%（26/30），对照组为56.67%（17/30），组间比较，治疗组 的愈显率明显优于对照组（P＜0.05）。（2）量表评分方面，治疗后，2组患者的PUQE评分、NVPPQOL评分和中医证候积分均 较治疗前明显降低（P＜0.05），且治疗组对 PUQE 评分、NVPPQOL 评分和中医证候积分的降低程度均明显优于对照组（P＜ 0.05）。（3）PUQE评分的影响因素方面，Pearson相关性分析结果显示，PUQE评分与患者妊娠年龄呈负相关（P＜0.05），与妊 娠周数、焦虑评分无相关性（P＞0.05）。（4）妊娠焦虑转阴率方面，治疗后，治疗组的妊娠焦虑转阴率为16.67%（5/30），对照 组为 6.67%（2/30），组间比较，差异无统计学意义（P＞0.05）。（5）尿酮体转阴率方面，治疗后，治疗组的尿酮体转阴率为 53.33%（16/30），对照组为13.33%（4/30），组间比较，治疗组的尿酮体转阴率明显高于对照组（P＜0.01）。（6）安全性方面，治 疗过程中，2组患者均无明显不良反应和不良事件发生，患者的血、尿常规和肝肾功能等安全性指标均无异常变化，具有较 高的安全性。【结论】 桂枝汤内服联合半夏茯苓汤穴位贴敷可有效缓解太阴证型妊娠恶阻患者的恶心、呕吐症状，改善患者 生活质量，提高尿酮体转阴率；同时表明患者的恶心、呕吐症状PUQE评分与年龄之间存在一定的相关性。

Objective To evaluate the clinical efficacy of oral administration of Guizhi Decoction combined with acupoint application of Banxia Fuling Decoction in the treatment of hyperemesis gravidarum（nausea and vomiting during pregnancy）of taiyin syndrome. Methods Sixty patients with hyperemesis gravidarum of taiyin syndrome were randomly divided into the treatment group and thecontrol group at the ratio of 1∶1，with 30 cases in each group. The control group was given acupoint application of Banxia Fuling Decoction on the acupoints of Zhongwan （CV12），bilateral Neiguan（PC6），bilateral Zusanli（ST36），and bilateral Yinlingquan（SP9）. The treatment group was treated with Guizhi Decoction orally on the basis of treatment for the control group. Both groups were treated for 2 weeks. The changes of Pregnancy-Unique Quantification of Emesis（PUQE）score， Nausea and Vomiting of Pregnancy Specific Quality of Life Questionnaire（NVPPQOL）score and traditional Chinese medicine （TCM）syndrome score in the two groups were observed before and after treatment. Multiple linear regression analysis was performed for the exploration of the influencing factors of PUQE score in the two groups before treatment. After treatment，the cured and markedly effective rate，negative conversion rate of pregnancy anxiety and negative conversion rate of urinary ketone bodies were compared between the two groups. Results（1）After 2 weeks of treatment，the cured and markedly effective rate of the treatment group was 86.67%（26/30），and that of the control group was 56.67%（17/30）. The intergroup comparison showed that the cured and markedly effective rate of the treatment group was significantly superior to that of the control group（P＜0.05）.（2）After treatment，the PUQE score，NVPPQOL score and TCM syndrome score of the two groups were significantly decreased compared with those before treatment（P＜0.05），and the decrease of PUQE score，NVPPQOL score and TCM syndrome score in the treatment group was significantly superior to that in the control group（P＜0.05）. （3）Pearson correlation analysis showed that PUQE score was negatively correlated with gestational age（P＜0.05），but had no correlation with gestational weeks and anxiety score（P＞0.05）.（4）After treatment，the negative conversion rate of pregnancy anxiety in the treatment group was 16.67%（5/30），and that in the control group was 6.67%（2/30）. There was no significant difference between the two groups（P＞0.05）.（5）After treatment，the negative conversion rate of urinary ketone bodies in the treatment group was 53.33%（16/30）， and that in the control group was 13.33%（4/30）. The intergroup comparison showed that the negative conversion rate of urinary ketone bodies in the treatment group was significantly higher than that in the control group（P＜0.01）.（6）There were no obvious adverse reactions or adverse events in the two groups during the treatment，and there were no abnormal changes in the blood and urine routine test，liver and kidney function indicators and other safety indexes of the patients，with high safety. Conclusion Oral administration of Guizhi Decoction combined with acupoint application of Banxia Fuling Decoction can effectively alleviate the symptoms of nausea and vomiting， improve the quality of life of patients， and increase the negative conversion rate of urinary ketone bodies in the patients with hyperemesis gravidarum of taiyin syndrome. Moreover，there is a certain correlation of the nausea and vomiting PUQE score with the age of the patients.

R271.9

广东省中医药局科研项目（编号：20182129）； 深圳市科创委资助项目（编号：JCYJ20180302144457509）