中医综合疗法对乳腺癌术后生活质量的影响

发布时间：2018-05-20 14:42

本文选题：乳腺癌 + 中医综合疗法　；参考：《南京中医药大学》2017年博士论文

【摘要】：目的:本研究基于乳腺癌为全球妇女最多见的恶性肿瘤,新发和死亡率均排行第一位;乳腺癌病损部位特殊、发病原因与情绪有关及其生存期长,更决定乳腺癌术后生存质量的重要性。本研究收集60例女性乳腺癌术后病例,探讨中医综合疗法,包括中医中药联合中医心理治疗对乳腺癌术后生活质量的影响,并将研究运用于临床治疗,不但有效地提高乳腺癌患者术后生活质量,包括减低临床症状,提高心理健康、改善特定思想行为模式,增强社会适用能力。并为进一步以中医综合疗法可减低乳腺癌复发转移作为今后临床、科研提供参考依据。方法:收集由2014-2016年在香港某癌症关顾中心所采集60例乳腺癌患者,均经手术治疗及病理确诊为乳腺癌,分实验组及对照组各30例。符合入选标准包括患者存在乳腺癌术后中医肝郁痰凝证型症状,主症包括神疲易倦、失眠多梦、抑郁/心烦易怒、便秘或便溏、纳呆;次症口苦或干、乳房胀痛、潮热、多汗、月经不调、上肢水肿/麻痹、关节疼痛/腰痛等。C型人格行为模式问卷反映着有情感抑压、自咎、偏执人格倾向。汉米尔顿抑郁量表HAMD为轻度抑郁或以上。及乳腺癌患者生命尛量测定量表EORTC-QLQ30反映着躯体、角色、认知、情绪及社会功能的不足。本实验包括12周中药疗程和4节中医心理治疗,观察分析治疗前后实验组及对照组乳腺癌患者生命尛量测定量表EORTC-QLQ30、中医临床症状问卷、汉米尔顿抑郁量表(HAMD)、C型人格行为模式问卷的对比。统计学方法采用SPSS22.0统计学软件包括建立数据库,将数据统一录入,本研究中资料符合正态分布,采用x±sd描述,P0.05为差异有统计学意义。结果:本研究经中医综合疗法包括12周中药疗程和4节中医心理治疗后,结果如下:1.生命尛量测定量表EORTC-QLQ30,在整体总健康生活质量实验组(3.95± 0.89),对照组为(3.10±1.08)。实验组明显提高有优越性,(P0.05)有统计学意义。在功能子量表:认知功能、情绪功能、社会功能均明显下降改善,反映着对比对照组,在综合疗法实验下焦虑和抑郁情绪有改善。在临床症状子量表:失眠、疲倦、气促等症状均明显下降改善,实验组对比对照组(P0.05)有统计学意义。2.在中医临床症状定量表的统计结果,主症神疲易倦、失眠多梦、抑郁/心烦易怒均效果明显。脾胃功能便秘/便溏、纳呆有效,(有显着效果(P0.05)。次症口苦或干有明显改善。潮热、乳房胀痛、关节疼痛/腰痛有效。在经化疗或免疫治疗后的临床症状,如多汗、月经不调和上肢水肿/麻痹等效果不及其他症状明显改进。3.在中医临床症状实验组的30例,经12周中医治疗,其中17例效果明显,9例有效,4例效果不明显。5项主症中3项有明显效果,2项有效;7项次症其中1项有明显效果,3项有效,3项效果不明显。4.HAMD汉米尔顿抑郁量表21项症状评分,实验组在通过中医综合治疗后,情绪方面,抑郁、迟滞、内咎;得分均下降有改善,实验组对比对照组有显着效果。焦虑层面:精神性焦虑及躯体焦虑得分均下降有改善。在躯体方面,全身症状、睡眠不深或困难对比对照组均有明显改善。5.C型行为模式观察得分显示,实验组在通过中医综合治疗后,得分≤6,由原来10名患者增至16名,得分7-10由16名减少至11名,反映着原本习惯抑压、自咎及偏执人格倾向的C型行为模式的患者有明显改善,患者趋向持开放态度,P0.05有差异统计意义。结论:本论文研究以采用中医综合疗法包括中医中药和中医心理治疗,综合4种不同问卷,进行纵横多维度观察乳腺癌术后生活质量,治疗前后的临床分级变化。乳腺癌术后生活质量在总体生活质量明显优越改善,反映着无论躯体、情绪、认知及社会功能等的优化,合符世界卫生组织(WHO)的生活质量定义,包括生理健康、正向认知和情绪的心理状况和正常社会关系。实验组经中医综合疗法的12周中药治疗后,中医临床症状中的神疲易倦、失眠多梦、抑郁/心烦易怒、口苦或干效果明显;便溏/便秘、纳呆、潮热、乳房胀痛、关节疼痛/腰痛有效;在化疗后多项如月经不调、上肢水肿/麻痹效果不明显。由于化疗毒害残留或需更长中医治疗时间、或采取针灸治疗更有优势,有待探讨。在月经不调的观察,多为化疗后冲任的破坏,需较长时间调理冲任。实验组经中医心理4节治疗后,HAMD抑郁量表显示抑郁情绪、迟滞、内咎,得分均下降,有明显改善。焦虑层面,精神性焦虑及躯体焦虑得分亦均下降有改善,并在躯体方面,全身症状、睡眠不深或困难症状有明显改善。实验组经中医心理4节心理疏导后,C型行为模式,即癌症易感行为模式的患者人数有明显减低。表示实验组患者原本存在抑压、自咎及偏执人格倾向,有趋向持开放态度,学会增强自控能力及释放焦虑、抑郁和愤怒情绪,调整和转移痛苦情感,尤其经小组分享大家苦难经验,学会公开表达自己的情绪和分享。在研究方面,以为期12周中药及4节中医心理治疗,临床症状有显着成效,但并未全面化,或需采取较长治疗时间及追踪查访,或配合其他中医治疗方法例如针灸深入探讨疗效。在心理情绪、思维性格模式范畴方面,经中医心理治疗后,成效立竿见影,某些轻症可能有着短期反应和回馈,若配合较长期的心理巩固治疗,使患者不断学习和加强自身素质,更能发挥其效益,最终达到提高及巩固患者生活质量的目的。
[Abstract]:Objective: This study is based on breast cancer as the most common malignant tumor in the world. Both the new hair and the mortality are the first. The site of the breast cancer is special. The cause of the disease is related to the mood and the long survival time. It is more important for the survival quality of breast cancer. This study collected 60 cases of female breast cancer after operation, and discussed the combination of traditional Chinese medicine. Therapy, including traditional Chinese medicine and traditional Chinese medicine psychotherapy on the quality of life after breast cancer surgery, and applied to clinical treatment, not only effectively improve the quality of life of breast cancer patients after operation, including reducing clinical symptoms, improving mental health, improving the pattern of specific thought and strengthening social application. Comprehensive medical treatment can reduce the recurrence and metastasis of breast cancer as a reference basis for future clinical research. Methods: 60 cases of breast cancer were collected from a cancer care center in Hongkong for 2014-2016 years. All of them were diagnosed as breast cancer by operation and pathology, and 30 cases were divided into experimental and control groups. After cancer, TCM liver depression and phlegm syndrome type of syndrome, the main symptoms include fatigue, insomnia, insomnia, depression / irritability, constipation or loose stool, and dry loose stool, dysphasia or dry, breast distention, hot tide, hyperhidrosis, irregular menstruation, upper limb edema / paralysis, joint pain / lumbago, etc. the.C model questionnaire reflects emotional pressure, self blame and paranoid personality. The Hamilton Depression Scale (HAMD) was a mild depression or above, and the measurement of life of breast cancer patients EORTC-QLQ30 reflects the deficiency of body, role, cognition, emotion and social function. This experiment includes 12 weeks of Chinese medicine course and 4 traditional Chinese medicine psychotherapy, and the experimental group and the control group of breast cancer patients before and after treatment Measurement scale EORTC-QLQ30, TCM clinical symptom questionnaire, Hamilton Depression Scale (HAMD), C personality behavior pattern questionnaire. Statistical method used SPSS22.0 statistics software to establish database, the data were recorded in a unified manner, the data in this study were in the normal distribution, X SD description, P0.05 as the difference was statistically significant. Results: after 12 weeks of traditional Chinese medicine treatment including 12 weeks of Chinese medicine treatment and 4 traditional Chinese medicine psychotherapy, the results were as follows: 1. life weight measurement scale (3.95 + 0.89) and the control group (3.10 + 1.08) in the total healthy quality of life test group (3.10 + 1.08). The experimental group was significantly superior, (P0.05) was statistically significant. In the functional subscale: Cognitive function, emotional function and social function were significantly decreased, reflecting the improvement of anxiety and depression in the contrast control group. The symptoms of insomnia, fatigue and breath were significantly decreased in the clinical syndrome scale, and the experimental group (P0.05) was statistically significant.2. in the TCM clinical symptom quantitative table. The statistical results showed that the main symptoms were tired, sleepless, dreaminess, depression / irritability. The spleen and stomach function was constipated / loose stool, and there was a significant effect (P0.05). The secondary symptoms were significantly improved. Hot flashes, breasts pain, joint pain / low back pain were effective. Clinical symptoms such as hyperhidrosis and menstrual disharmony after chemotherapy or immunotherapy. The effect of upper limb edema / paralysis was less obvious than other symptoms of.3. in 30 cases of TCM clinical symptom experimental group. After 12 weeks of traditional Chinese medicine treatment, 17 cases were effective, 9 cases were effective, 4 cases had no obvious effect in.5, 2 were effective, 7 of which 1 had obvious effect, 3 effective, 3 effect was not obvious.4.HAMD Chinese rice. 21 symptoms of the Depression Scale were scored in the experimental group, after the comprehensive treatment of traditional Chinese medicine, emotional, depression, retardation, and internal blame; the scores were decreased and the experimental group had a significant effect. The anxiety level: the scores of mental anxiety and body anxiety decreased. In the body, the general symptoms, the sleep is not deep or the difficulty was compared. In the control group, the score of.5.C type behavior pattern was obviously improved. The score of the experimental group was less than 6 after the comprehensive treatment of traditional Chinese medicine. The score was increased from 10 patients to 16, and the score was 7-10 from 16 to 11, which reflected the obvious improvement of the patients with the original habit and the tendency to blame and paranoid personality. The patients tended to be open. In this paper, 4 different questionnaires were used to observe the quality of life after breast cancer surgery and the clinical grading changes before and after treatment. The quality of life of breast cancer after operation was obviously superior to the overall quality of life. Improvement, reflecting the optimization of physical, emotional, cognitive, and social functions, and the definition of the quality of life of the WHO (WHO), including physical health, positive cognitive and emotional psychological conditions and normal social relations. After 12 weeks of medicine treatment in the experimental group, the clinical symptoms of traditional Chinese Medicine are tired and sleeplessness. Dream, depressive / annoying irritability, bitter or dry effect; loose stool / constipation, tanning, hot tide, breast pain, joint pain / low back pain are effective; after chemotherapy, the effect of upper limb edema / paralysis is not obvious. After the 4 section of Chinese medicine, the HAMD depression scale showed depression, retardation, and inner blame. The scores of the depression, the anxiety level, the mental anxiety and the body anxiety were also improved, and the physical, systemic symptoms, and sleep were also improved. After 4 sections of psychological counseling in Chinese medicine, the number of patients with type C behavior pattern, that is, the pattern of susceptibility to cancer, was significantly reduced in the experimental group. It indicated that the patients in the experimental group had a suppression, self and paranoid personality tendency, an open attitude, and the ability to enhance self-control and release anxiety and depression. And anger, adjust and transfer painful emotions, especially by sharing your suffering experience, and learn to express their feelings and share openly. In the study, 12 weeks of traditional Chinese medicine and 4 traditional Chinese medicine psychotherapy, clinical symptoms have significant effect, but not comprehensive, or take longer treatment time and follow-up visit, or to cooperate with the other The treatment methods of traditional Chinese medicine, such as acupuncture and moxibustion, discuss the curative effect deeply. In the category of psychological emotion and thinking character pattern, after the psychological treatment of Chinese medicine, the effect is immediately visible. Some light symptoms may have short-term response and feedback. If it is combined with long-term psychological consolidation therapy, the patients can learn and strengthen their own quality constantly and give full play to their benefits. To achieve the purpose of improving and consolidating the quality of life of the patients.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R273

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