穴位埋线防治乳腺癌术后化疗不良反应的临床研究

发布时间：2018-01-04 08:01

  本文关键词：穴位埋线防治乳腺癌术后化疗不良反应的临床研究　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 穴位埋线 乳腺癌术后 化疗不良反应

【摘要】：乳腺癌(Breast cancer)是由乳腺导管上皮发生的恶性肿瘤。受人口老年化和生活方式改变的影响,我国乳腺癌的发病率呈低龄化趋势。据2015年全国肿瘤登记处的数据统计,中国大约有27万人次发病,约7万次人死于乳腺癌。目前,除了以手术与放疗为主的局部治疗方式外,局部与全身相结合的新型治疗方式,如化疗、内分泌治疗及中医药治疗等,被广泛应用于临床。其中化疗作为乳腺癌术后辅助治疗的三大重要手段,可一定程度降低患者的病死率,发挥着不可替代的作用。但化疗引起的一系列不良反应,包括消化道不良反应(如食欲减退、恶心呕吐、腹泻腹痛或便秘等)和骨髓抑制(如全血细胞降低,以白细胞下降最明显),严重影响患者的精神状态,阻碍治疗进程,影响临床疗效。因此,乳腺癌术后化疗引起的不良反应是目前乳腺癌术后临床研究的重点之一。有学者认为,中医药治疗乳腺癌术后化疗引起的不良反应疗效显著,其中穴位埋线疗法以其刺激作用持久、间隔时间长、操作简便、成本低廉的特色,成为近年来研究和探讨的热点。故本研究选用穴位埋线防治乳腺癌术后化疗的不良反应,以期进一步改善患者的生存质量,提高临床疗效。目的:采用穴位埋线防治乳腺癌术后化疗引起的不良反应,并与单纯西药常规治疗相对比,以进一步改善患者的生存质量,提高临床疗效,为穴位埋线防治乳腺癌术后化疗不良反应提供重要的科学依据。方法:将符合诊断、纳入及排除标准的乳腺癌术后化疗患者,按随机数字表的方法,分为治疗组(即穴位埋线+西药常规)30例和对照组(即西药常规)28例。对照组予常规止呕治疗,必要时予升白细胞及抗感染治疗。治疗组在对照组的基础上加予穴位埋线。第一组选穴:中脘、气海、胃俞(双)、肾俞(双)、足三里(双);第二组选穴:天枢(双)、关元、大椎、脾俞(双)、上巨虚(双)。两组穴位交替进行。分别记录第1~4个化疗周期后两组患者有无食欲减退、恶心呕吐、腹泻和便秘,化疗后第9d白细胞计数变化情况,以及血小板计数和血红蛋白下降程度(阳性率)。若所有数据符合正态分布,则以(均数土标准差)的形式表现,计量资料采用t检验,计数资料采用χ2检验,假设检验统一使用双侧检验,得出检验统计量及其对应的P值,若P0.05则有统计学意义。对于非正态分布数据,经对数转换后再分析。所有数据均采用SPSS 20.0进行分析数据。结果:1.治疗组和对照组的一般资料,如年龄、病程、白细胞计数、TNM临床分期等,经统计分析无显著性差异(P0.05),具有可比性。2.经穴位埋线治疗后,治疗组在第1~4个化疗周期后的消化道不良反应(包括食欲减退、恶心呕吐、腹泻和便秘)较对照组均明显减少(P0.05);3.治疗组在每次化疗后第9d白细胞计数下降情况较对照组减少减轻(P0.05);治疗组在4个化疗周期内,应用重组人粒细胞集落刺激因子的情况较对照组少(P0.05),而应用抗生素的情况,两组比较无显著差异(P0.05)。4.治疗组在第1个化疗周期后第9d血小板计数下降程度(阳性率)方面较对照组,差异无统计学意义(P0.05),主要考虑血小板代谢时间较长,故在第1个化疗周期后治疗组较对照组无明显减轻;在第2~4个化疗周期后第9d血小板计数下降程度(阳性率)方面,对照组与治疗组相比下降明显(P0.05)。5.治疗组在第1个化疗周期后第9d血红蛋白下降程度(阳性率)方面较对照组,差异无统计学意义(P0.05),主要考虑血红蛋白代谢时间较长,故在第1个化疗周期后治疗组较对照组无明显减轻;在第2~4个化疗周期后第9d血红蛋白下降程度(阳性率)方面,对照组与治疗组相比下降明显(P0.05)。结论:穴位埋线能有效减轻乳腺癌术后化疗引起的不良反应,治疗组在食欲减退、恶心呕吐、腹泻和便秘等消化道不良反应方面较对照组明显减轻;白细胞计数下降情况较对照组显著减少;血小板计数和血红蛋白下降程度方面,对照组与治疗组相比下降明显。研究表明,穴位埋线可有效提高自身机体免疫,保护造血机能,调节胃肠功能,降低化疗引起的不良反应,提高患者的生存质量,且该疗法经济安全、简便有效,值得进一步临床研究和推广。
[Abstract]:Breast cancer (Breast cancer) is produced by the breast ductal cancer. Affected by the aging population and lifestyle changes, the incidence of breast cancer in China showed a trend of younger age. According to the 2015 National Cancer Registry data statistics, about 270 thousand people China disease, about 70 thousand people died of breast cancer. At present, in addition to local treatment with surgery and radiotherapy, new therapeutic approaches, the combination of local and systemic chemotherapy, endocrine therapy and traditional Chinese medicine treatment, has been widely used in clinic. The chemotherapy for postoperative breast cancer auxiliary three important means of treatment, can reduce the mortality of the patients with a certain degree rate, plays an irreplaceable role. But a series of adverse reactions caused by chemotherapy, including gastrointestinal adverse reactions (such as anorexia, nausea and vomiting, abdominal pain, diarrhea or constipation) and bone marrow suppression (such as blood cell drop Low to white blood cells decreased most obviously), seriously affect the patient's mental state, hinder the treatment process, the clinical therapeutic effect. Therefore, the adverse reactions caused by chemotherapy after breast cancer surgery is currently the postoperative breast cancer clinical research focus. Some scholars believe that the adverse reaction caused by chemotherapy efficacy of traditional Chinese medicine in the treatment of breast cancer patients after significant, the catgut embedding therapy for its stimulating effect lasting, long time interval, simple operation, low cost characteristics, become a research hotspot in recent years and discuss the adverse reaction. So this study selected acupoint catgut embedding for breast cancer prevention and treatment of postoperative chemotherapy, in order to further improve the quality of life of patients, improve the curative effect. Objective: adverse reactions caused by chemotherapy for breast cancer prevention and treatment by acupoint catgut embedding therapy after operation, and compared with the conventional treatment of Western medicine alone, to further improve the quality of life of patients, improve the clinical efficacy, to the point Provide an important scientific basis for prevention and treatment of adverse reaction of chemotherapy catgut embedding therapy after breast cancer surgery. Methods: according to the diagnosis, inclusion and exclusion criteria of the breast cancer patients with postoperative chemotherapy, according to the random number table method, divided into the treatment group (i.e. conventional western medicine + acupoint catgut embedding) 30 cases and the control group (i.e. conventional Western Medicine) 28 cases the control group received routine antiemetic treatment, when necessary to increase white blood cell and anti infection treatment. The treatment group on the basis of control group. The first group was treated with acupoint catgut embedding choose Zhongwan, Qihai, Weishu (double) and Shenshu (double), Zusanli (double); second groups of acupoints: Tianshu (double), Guan yuan, Dazhui, Pishu (double), Shangjuxu (double). The two groups were recorded. The alternating points 1~4 cycles after two groups of patients with and without loss of appetite, nausea and vomiting, diarrhea and constipation, changes in 9D white blood cell count and platelet count and after chemotherapy. Hemoglobin decreased (positive rate). If all the data to conform to normal distribution, with (mean + standard deviation) of the form, measurement data using t test, count data using chi square test 2, unified hypothesis testing using two-sided test, the test statistic and its corresponding P value, if P0.05 had statistical significance. For the non normal distribution of data. After log transformation analysis. All the data were analyzed by means of SPSS 20 data. Results: the general data, 1. treatment group and control group, such as age, course of disease, white blood cell count, TNM clinical stage, there were no statistically significant differences (P0.05), comparable to.2. by acupoint catgut embedding therapy after treatment gastrointestinal adverse reactions, the treatment group in the first 1~4 after the chemotherapy cycle (including loss of appetite, nausea and vomiting, diarrhea and constipation) were significantly reduced compared with the control group (P0.05); 3. in the treatment group at 9D after chemotherapy the white blood cell count decreased compared with the control group decreased Reduce (P0.05); the treatment group in the 4 cycle of chemotherapy, the application of recombinant human granulocyte colony-stimulating factor of less than that of the control group (P0.05), and the application of antibiotics, the two groups had no significant difference (P0.05).4. treatment group in the first cycle of chemotherapy and 9D after platelet count decreased (the positive rate of) than the control group, the difference was not statistically significant (P0.05), the main consideration of platelet metabolism over a long period of time, the first cycle of chemotherapy after the treatment group than in control group significantly reduced; in the first 2~4 cycle of chemotherapy and 9D after platelet count decreased (positive rate), the control group compared with treatment group (P0.05).5. decreased significantly in the treatment group 9D after first cycles of chemotherapy hemoglobin decline degree (positive rate) than the control group, the difference was not statistically significant (P0.05), the main consideration of hemoglobin metabolism between the longer, so in first cycles after treatment group Compared with the control group decreased; in the first 2~4 cycles of chemotherapy after 9D hemoglobin decline degree (positive rate), the control group compared with treatment group decreased significantly (P0.05). Conclusion: catgut implantation can effectively reduce the adverse reactions caused by chemotherapy after breast cancer surgery, in the treatment group were anorexia, nausea and vomiting, diarrhea and constipation and other gastrointestinal adverse reactions than the control group significantly reduced; white blood cell count decreased significantly compared with the control group decreased; platelet count and hemoglobin decreased, compared with the control group and the treatment group decreased significantly. The results show that acupoint catgut embedding therapy can effectively improve their immunity, protect hematopoietic function, regulate gastrointestinal function, reduce the adverse the reaction caused by chemotherapy, improve the quality of life of patients, and the therapy is simple and effective, economic and safe, worthy of further clinical study and promotion.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.5
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本文编号：1377719