加味仙方活命饮外用治疗卡培他滨所致手足综合征的临床研究

发布时间：2017-12-26 17:44

本文关键词：加味仙方活命饮外用治疗卡培他滨所致手足综合征的临床研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：本论文包括文献综述和临床研究两个部分。文献综述共2篇,第一篇为西医综述,回顾了西医对手足综合征的认识及防治研究进展,包括引起手足综合征的常见化疗药物、卡培他滨的临床应用、手足综合征的发生机制、临床表现、分级诊断标准以及西药防治手足综合征的现状。手足综合征是卡培他滨化疗过程中最常见的不良反应之一,主要表现为掌跖部感觉障碍及红斑,严重者可见溃疡、脱屑及剧烈疼痛。手足综合征降低了患者的生活质量,同时影响了卡培他滨化疗过程的顺利进行,常常导致药物减量或中断治疗,严重影响了化疗的预期临床疗效。现代医学对其发病机制做了有意义的探索,但仍未达成共识。在治疗方面,提倡健康宣教、局部护理等一般治疗及维生素B6、环氧化酶抑制剂、DPD酶抑制剂等药物治疗,但防治疗效并不理想,临床有效率并不满意,有待于进一步深入探索与研究。第二篇为中医综述,回顾了中医对手足综合征的认识,以及近年来中医药防治手足综合征的研究进展,对中医药不同临床剂型的应用做了初步总结,包括外用剂、内服剂、注射剂、灸法等。着重总结了外用制剂的临床应用,如外洗剂、熏洗剂、油剂、散剂、膏剂等。中医药各类制剂以疗效佳、副作用小,广泛地应用于手足综合征的防治中。大量学者基于临床观察证实,中医药对手足综合征具有独特的防治优势。但各医家对本病的认识观点不一,治疗思路亦不尽相同,仍有待我们进一步发掘与探索。并从几个方面论述了本项临床观察。基于肿瘤患者的特殊体质及卡培他滨化疗引起的不良反应,得出手足综合征可能的发病机理为"瘀、热、毒搏结难解,客于手足部络脉,损伤脉络筋经",并辨证为"瘀热入络证"。确立"化瘀、清热、解毒"为治疗大法,选择清热解毒的代表方剂仙方活命饮为基础方,甄选药物加减化裁,制成外用汤剂进行临床干预性研究,旨在研究其对HFS的治疗意义,为HFS的防治提供新的可借鉴的方法和途径。临床研究部分,观察并总结了加味仙方活命饮外用对卡培他滨所致手足综合征的临床疗效。[研究目的]观察加味仙方活命饮外用治疗手足综合征的临床疗效及安全性。[研究方法]本课题按照纳入标准,纳入30例卡培他滨化疗的肿瘤患者,采用前后自身对照的方法,予加味仙方活命饮煎汤温浴手足,每次30min,每天2次,早晚各一次。温浴后即予药包外敷患处,每次30min,每天2次。7天为1个疗程,共2个疗程。治疗前后分别进行手足综合征分级评价、临床症状评分、疼痛程度评分及一般状态评分,并评估疗效及安全性。[研究结果]30例患者中,有18例患者HFS临床分级下降,8例患者维持稳定状态;有26例患者临床症状不同程度减轻,总有效率为86.67%(26/30);疼痛总缓解率为90%(27/30),完全缓解率为36.67%(11/30);一般状态(精神状态、情志、食欲及睡眠)总改善率为80%(24/30)。且治疗前后未出现皮肤过敏、皮疹等不良反应。各项数据比较,P值均0.05,差异具有统计学意义。[研究结论]加味仙方活命饮外用对卡培他滨化疗所致的手足综合征具有一定疗效,且安全性尚可,值得进一步临床推广研究。
[Abstract]:This paper consists of two parts: literature review and clinical research. The literature review consists of 2 parts, the first part is the review, review the research progress of Western medicine recognition and prevention of hand foot syndrome, including common chemotherapy drugs and handfoot syndrome of capecitabine and clinical application of hand foot syndrome pathogenesis, clinical manifestations, diagnostic criteria and classification status of Western medicine comprehensive prevention of hand foot sign. Hand foot syndrome is one of the most common adverse reactions of capecitabine chemotherapy process, mainly for sensory disturbance and palmoplantar erythema, severe visible ulcer, desquamation and severe pain. Hand foot syndrome reduces the quality of life of patients, and affects the successful progress of capecitabine chemotherapy, which often leads to drug loss or interruption, which seriously affects the expected clinical efficacy of chemotherapy. Modern medicine has made meaningful exploration to its pathogenesis, but no consensus has been reached. In terms of treatment, we advocate health education, local care and other general treatment and vitamin B6, cyclooxygenase inhibitors, DPD enzyme inhibitors and other drugs, but the curative effect is not ideal, the clinical efficiency is not satisfied, and needs further exploration and research. The second article review of Chinese medicine, reviewed the understanding of Chinese medicine on hand foot syndrome, and in recent years the study of hand foot syndrome of Chinese medicine in the prevention and application of traditional Chinese medicine in different clinical forms made a preliminary summary, including topical agent, oral agent, injection and moxibustion etc.. The clinical application of external preparation, such as external lotion, fumigant, oil, powder, plaster and so on, was summarized. The traditional Chinese medicine is widely used in the prevention and treatment of hand foot syndrome with good curative effect and small side effect. A large number of scholars have proved that traditional Chinese medicine has a unique preventive advantage on hand foot syndrome based on clinical observation. However, doctors have different views on the disease, and the treatment ideas are not the same. It still needs to be further explored and explored. The clinical observation is discussed from several aspects. Based on the special physical constitution and adverse reactions caused by capecitabine chemotherapy, the possible pathogenesis of hand foot syndrome is "stasis, heat, toxin and collaterals", "the meridian of the hand and foot is collateral, and the meridian channel is damaged", and it is identified as "stasis heat entering the collateral syndrome". The establishment of "removing blood stasis, clearing heat, detoxification treatment method, choose the representative prescription of Xian Fang Huo Ming Yin Qingrejiedu based drug selection, chmical process, research into external Decoction clinical intervention, in order to study on the treatment of HFS, provides the method and the way new for the prevention and treatment of HFS. In the part of clinical study, the clinical effect of Jiawei Xianfang activating drink on hand and foot syndrome caused by capecitabine was observed and summarized. [Objective] to observe the clinical efficacy and safety of Jiawei Xian Fang Decoction for external use in the treatment of hand foot syndrome. [Methods] according to the inclusion criteria, 30 cases of tumor patients in capecitabine chemotherapy. Methods before and after treatment, treated with the modified by xianfanghuomingyin frying bath we brothers, 30min each time, 2 times a day, sooner or later each time. After a warm bath, it is given to the affected area with a package of 30min, 2 times a day. 7 days for 1 courses, a total of 2 courses. The grading evaluation of hand foot syndrome, clinical symptom score, pain degree score and general state score were carried out before and after treatment, and the efficacy and safety were evaluated. [results]30 patients, clinical classification of 18 cases of patients with HFS decreased, 8 patients remain stable; there are 26 cases of patients with clinical symptoms were alleviated, the total effective rate was 86.67% (26/30); pain the total remission rate was 90% (27/30), the complete remission rate was 36.67% (11/30); the general state (mental state, emotion, appetite and sleep) the total improvement rate was 80% (24/30). There were no adverse reactions such as skin allergy and skin rash before and after treatment. The P values were 0.05, and the difference was statistically significant. [Conclusion] external application of jiaxianxianhuo Yin has certain effect on hand foot syndrome caused by capecitabine chemotherapy, and its safety is acceptable. It is worthy of further clinical research.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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