养阴清肺凉血方治疗放射性肺炎临床疗效观察

发布时间：2018-01-09 00:02

本文关键词：养阴清肺凉血方治疗放射性肺炎临床疗效观察　出处：《河北大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:放射性治疗(下文简称放疗)是被广泛运用于肺癌、乳腺癌、食管癌、纵隔肿瘤、胸腺肿瘤等胸部肿瘤治疗中。在胸部各器官组织中,肺对辐射相对敏感,在超过肺部生物效应阈值的放射线剂量照射后,肿瘤周围的肺组织会产生程度轻重不一的受损,同时,在放射野内的正常肺组织受到放射后也会产生损伤导致炎症反应,这种炎症反应被称为放射性肺损伤(RILI)。由于在放疗过程中,正常肺组织也一同受到照射,不可避免地会受到损伤,放射剂量随之受到限制,最终会致使肿瘤局部治疗效果的降低甚至是放疗方案的中断,严重困扰放疗过程。其发生率达5%—15%。放射学改变的发生率则高达15%—100%。放射性肺损伤早期表现为放射性肺炎(RP),属于急性期反应,肺实质受损程度较轻,早期介入,通过系统治疗尚可逆转;放射性肺炎若无有效控制,肺实质严重受损,往往会不可逆发展为肺纤维化,发展到晚期即放射性肺纤维化(RPF)。一旦发生放射性肺损伤,将严重影响患者的治疗效果、生活质量及预后,甚则直接导致死亡。因此,尽早治疗放射性肺炎、控制并发症具有极大的临床价值。方法:两组分别给予在(1)肺炎Ⅰ、Ⅱ级:注射用甲泼尼龙0.5-1mg/kg/d,静脉滴入,依据病情调整剂量,症状好转逐步降低剂量,持续2-6周,同时给予预防性使用抗生素。(2)肺炎Ⅲ级:注射用甲泼尼龙1-1.5mg/kg/d,静脉滴入,依据病情调整剂量,症状好转逐步降低剂量,持续2-6周,同时给予预防性使用抗生素。治疗组以上方案为基础,加用养阴清肺凉血方口服治疗,其方剂组成如下:黄芩20g,丹皮15g,丹参20g,赤芍20g,天冬20g,玄参20g,五味子12g,竹茹10g,桑白皮15g,天花粉15g,杏仁10g。水煎服,日1剂,分早晚2次温服,4周为一疗程,连续使用3个疗程,共计12周。分别在治疗4周,8周,12周时观察患者咳嗽,气短,乏力等中医症状变化,以此建立评分表,评分项目包括患者呼吸困难程度、肺功能及身体机能状态,通过两组患者的评分差异,分析治疗放射性肺炎的综合疗效和患者身体状况变化,并初步探索养阴清肺凉血方联合抗生素、激素中西医结合治疗放射性肺炎的临床疗效。结果:本实验含治疗组(中西医结合方案)30例,对照组(单纯西医方案)30例,共计60例患者。对比发现,治疗组总有效率90%,高于对照组总有效率73.3%,P0.05,结果具有统计学意义,结论:治疗组疗效明显优于对照组。结论:通过对比观察实验,养阴清肺凉血方联合抗生素、激素中西医结合治疗放射性肺炎,疗效显著优于单纯西医治疗,在中医学整体观点、辨证论治思想指导下,通过四诊合参,具体分析患者病情阶段、临床表现、基础疾病等,显示中药养阴清肺凉血方临床治疗放射性肺炎的临床疗效确切,可有效缓解和改善患者胸闷、气短、咳嗽、咯痰等临床症状,降低毒副作用,提高总体疗效,改善患者生活质量,维持身心健康。养阴清肺凉血方建立在多年临床经验总结的基础上,组方科学合理,疗效确切可靠,明显改善临床症状,缓解患者疼痛,是治疗放射性肺炎的安全可靠用药。
[Abstract]:Purpose: radiation therapy (hereinafter referred to as radiotherapy) is widely used in lung cancer, breast cancer, esophageal cancer, mediastinal tumor, thymus tumor and other chest cancer treatment. In various organs in the chest and lung are relatively sensitive to radiation in the radiation biological effect threshold dose over the lungs after irradiation damage around the tumor the lung tissue will produce a degree at the same time, by radiation in the radiation field in the normal lung tissue will produce inflammation, the inflammation is called radioactive lung injury (RILI). The radiotherapy process, normal lung tissue were affected by irradiation, will inevitably damage, radiation the dose will be restricted, reduce will eventually cause local tumor treatment and even interrupt radiotherapy, serious problems of radiotherapy process. The incidence of up to 5% 15%. X-ray change is as high as 15 % - 100%. of radiation-induced lung injury in early stage of radiation pneumonitis (RP), which belongs to the acute phase response of lung parenchyma damaged to a lesser extent, early intervention, the treatment system is reversible; if there is no effective control of radioactive pneumonia, lung parenchyma severely damaged, often irreversible for the development of pulmonary fibrosis, to the development of advanced radioactive pulmonary fibrosis (RPF). Once the occurrence of radiation-induced lung injury, will seriously affect the patient's treatment effect, life quality and prognosis, even a direct cause of death. Therefore, the treatment of Radioactive Pneumonia as soon as possible, is of great clinical value in the control of complications. Methods: two groups were given in (1) pneumonia I, II: 0.5-1mg/kg/d injection of methylprednisolone, intravenous infusion, dose adjustment according to the illness, the symptoms gradually reduce the dose for 2-6 weeks, while giving prophylactic antibiotics. (2): 1-1.5mg/kg/d pneumonia III methylprednisolone intravenous injection. Infusion dose adjustment according to the illness, symptoms gradually reduce the dose for 2-6 weeks, while giving prophylactic use of antibiotics. The treatment group above as a basis, combined with Yangyin Qingfei Liangxue Decoction oral treatment, the prescription is as follows: 20g of Radix Scutellariae, paeonol 15g, 20g Salvia miltiorrhiza, Radix Paeoniae Rubra 20g, aspartate 20g, Scrophularia 20g. Schisandra 12g, 10g Zhuru, 15g Sangbaipi, trichosanthin 15g, almond 10g. water decoction, daily 1 agent, and the 2 day, 4 weeks for a course of treatment, continuous use of 3 courses, a total of 12 weeks. In the treatment of 4 weeks, 8 weeks, 12 weeks were observed in patients with cough, shortness of breath, change fatigue and other symptoms of traditional Chinese medicine, in order to establish the scale, scores include dyspnea, pulmonary function and body function condition, the score between the two groups of patients, analysis of changes in the treatment of radiation pneumonia curative effect and physical condition of patients, and to explore the Yangyinqingfei Liangxue decoction combined with anti Antibiotics, clinical curative effect of the treatment of radiation pneumonitis with hormone and Western medicine. Results: the treatment group (including the scheme of combining traditional Chinese and Western medicine in 30 cases), control group (Western medicine regimen) in 30 cases, a total of 60 patients. By comparison, the total effective rate of treatment group 90% was higher than the control group, the total efficiency of 73.3%, P0.05 and the results have statistical significance, conclusion: the curative effect of treatment group was significantly better than the control group. Conclusion: through the contrast experiment, Yangyin Qingfei Liangxue decoction combined with antibiotics, the treatment of Radioactive Pneumonia Combined with hormone of TCM and Western medicine, the curative effect was significantly better than the pure western medicine treatment, traditional Chinese medicine in the overall view of syndrome differentiation theory, through the combination of all the specific. Analysis of the disease stage, clinical manifestations, basic diseases, show the clinical curative effect of traditional Chinese medicine Yin Qingfei Liangxue Decoction clinical treatment of radiation pneumonitis is effective, alleviate and improve the patients with chest tightness, shortness of breath, cough, expectoration, effective, etc. The clinical symptoms, reduce side effects and improve the overall curative effect, improve the life quality of patients, to maintain physical and mental health. Yangyinqingfei Liangxue Decoction based on years of clinical experience, the prescription is scientific and reasonable, reliable curative effect, improve clinical symptoms, relieve the pain of patients, is a safe and reliable treatment of radiation pneumonitis.

【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.55

【参考文献】