增液汤加味改善鼻咽癌放疗口干燥症及核素动态显像定量评价的研究

发布时间：2018-05-10 14:52

  本文选题：鼻咽癌 + 放射治疗　； 参考：《广州中医药大学》2011年硕士论文

【摘要】：背景及目的 口干燥症是鼻咽癌放疗后最常见的后遗症之一,严重影响患者的生存质量。本研究旨在探讨鼻咽癌放疗后口干燥症的严重程度及其对日常生活的影响,观察增液汤加味对鼻咽癌放疗所致的唾液腺损伤的保护作用,客观评价中医药干预鼻咽癌放疗后副反应口干燥症的影响。 方法 选择我院2009年12月-2010年12月收治的65例确诊为鼻咽癌,并进行首次放疗的患者,随机分成两组,其中治疗组(中药+放疗)34例,对照组(单纯放疗)31例。最终剔除5例,有效病例数60例,其中治疗组33例,对照组27例。于DT 0、10、20、30、40、50、60Gy及放疗结束时,分别记录口腔黏膜情况,检测唾液PH值；放疗前后行面对面访谈式的口干问卷调查及口干程度VAS评分,并行SPECT核素动态显像定量分析,利用SPECT机的R.O. Isequence软件对放疗前后腮腺核素动态显像后的UI、El值数据分析,客观评价放疗前后鼻咽癌患者唾液腺功能。 结果 所有患者在放疗中均出现放射性口腔黏膜反应,其严重程度与放射剂量相关；治疗组放射性口腔黏膜反应轻于对照组(P0.01)。在DT≤30Gy时,Ⅰ度、Ⅱ度黏膜反应组间比较有显著性差异(P0.01)。DT40Gy时,Ⅲ度黏膜反应组间无显著差异；在DT 70Gy时,Ⅱ度、Ⅳ度黏膜反应组间比较有显著性差异(P0.01)。随着剂量的增加,SPECT核素动态显像定量显示两组前后腮腺功能摄取-排泌功能均较前下降,以排泌功能下降为主；治疗组腮腺UI、EI较放疗前分别下降29.1%、44.3%；对照组腮腺UI、E1分别较放疗前分别下降44.3%、74.1%；但治疗组下降的程度轻于对照组。放疗后二组口腔pH值均低于正常范围(6.5-7),口腔pH的异常与急性口腔黏膜反应发生有相关性；60例患者均有不同程度的口干,二组各有54.6%、77.9%发生中到重度口干。治疗组与对照组对口干VAS评分有显著差异(P0.01)。 结论 鼻咽癌患者放疗后均有不同程度的口干；鼻咽癌放疗后口干燥症对患者讲话、咀嚼、吞咽、睡眠有严重影响,患牙病的几率增加。SPECT核素动态显像定量分析方法是评价鼻咽癌患者放疗后唾液腺功能受损程度的敏感、实用的方法,腮腺功能损伤以排泌功能受损为主。增液汤加味含漱配合内服可推迟放射性口腔黏膜反应出现的时间,减轻放疗反应后口干症状,提高患者的生存质量,具有一定的临床推广应用价值。
[Abstract]:Background and purpose Xerostomia is one of the most common sequelae of nasopharyngeal carcinoma after radiotherapy, which seriously affects the quality of life of patients. The purpose of this study was to investigate the severity of xerostomia after radiotherapy for nasopharyngeal carcinoma and its influence on daily life, and to observe the protective effect of Zengye decoction on salivary gland injury induced by radiotherapy for nasopharyngeal carcinoma. Objective to evaluate the effect of traditional Chinese medicine (TCM) on desiccation of side reaction after radiotherapy for nasopharyngeal carcinoma (NPC). Method From December 2009 to December 2010, 65 patients with nasopharyngeal carcinoma (NPC) were randomly divided into two groups: treatment group (34 cases) and control group (31 cases). Finally, 5 cases were eliminated, 60 cases were effective, including 33 cases in treatment group and 27 cases in control group. Oral mucosa was recorded and saliva PH was detected at the end of radiotherapy, oral dry questionnaire and VAS score were performed before and after radiotherapy, and quantitative analysis of SPECT radionuclide dynamic imaging was performed before and after radiotherapy. The function of salivary gland in patients with nasopharyngeal carcinoma (NPC) was evaluated objectively by using the software R.O. Isequence of SPECT machine to analyze the UIN El value of parotid nuclide dynamic imaging before and after radiotherapy. Result Radiation oral mucosal reaction was found in all patients, and the severity was correlated with the dose of radiation, and the radiation oral mucosal reaction in the treatment group was less than that in the control group (P 0.01). When DT 鈮，

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