黄诱桂枝五物汤化裁防治奥沙利铂引起的外周神经毒性的临床观察

发布时间：2018-01-30 20:30

本文关键词： 黄芪桂枝五物汤奥沙利铂神经毒性肌电图　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过观察黄芪桂枝五物汤化裁方对恶性肿瘤患者化疗后外周神经毒性症状分级、化疗前后肌电图等指标的影响,评价其临床综合疗效,从而为恶性肿瘤患者化疗后毒副反应的防治手段提供可靠的临床数据和临床基础,增加提高化疗患者生活质量的手段。方法:采用前瞻性、随机对照的临床研究方法。选取样本量66例,使用随机区组设计方案,以患者入组时间作为配伍因素,将入院后拟行FOLFOX6化疗方案并符合纳入标准的恶性肿瘤患者入组并进行分组,分为治疗组(中药+化疗)33例和对照组(单纯化疗)33例,治疗组患者从第一次化疗开始口服中药,以黄芪桂枝五物汤为主方化裁,持续至六个周期化疗结束,对照组采用单纯化疗;研究所需收集的数据包括患者化疗后的外周神经毒性症状,第一次化疗前和六周期化疗结束后各条神经的运动神经传导速度(MNCV)与感觉神经传导速度(SCV),以及各项安全性指标,最后将数据进行分析总结。结果:1、治疗组外周神经毒性症状及体征的发生率明显小于对照组,且临床表现较对照组轻微(P0.01);2、化疗前后运动神经传导速度(MNCV)呈下降趋势,治疗组左侧尺神经、左侧腓神经有统计学差异(P0.05),左侧正中神经、右侧正中神经、右侧尺神经、右侧腓神经无统计学差异(P0.05);对照组化疗前后左侧正中神经、右侧正中神经、左侧尺神经、右侧尺神经有统计学差异(P0.05),右侧尺神经、右侧腓神经无统计学差异(P0.05);3、化疗后运动神经传导速度(MNCV)比较,右侧正中神经组间比较有统计学差异(P0.05),左侧尺神经化疗前后差值组间比较无统计学差异(P0.05),余神经组间比较无统计学差异(P0.05);若综合运动神经的数据,化疗前后比较无统计学差异(P0.05),化疗后组间比较无统计学差异(P0.05)。4、对于感觉神经传导速度(SCV),化疗前后呈下降趋势,各条感觉神经化疗前后对比均有统计学差异(P0.01),两组化疗后数据对比有统计学差异(P0.01)。结论:黄芪桂枝五物汤化裁方在临床上对奥沙利铂化疗所致外周神经毒性的预防与治疗是有意义的,能够防止化疗外周神经毒性的发生及加重。
[Abstract]:Objective: to observe the effect of Huangqi Guizhi Wuwu decoction on the classification of peripheral neurotoxic symptoms and electromyography (EMG) in patients with malignant tumor after chemotherapy. So as to provide reliable clinical data and clinical basis for the prevention and treatment of side effects after chemotherapy in patients with malignant tumor, and increase the means to improve the quality of life of patients with chemotherapy. A randomized controlled clinical study was conducted. 66 samples were selected and randomized block design was used. The time of patients entering the group was taken as the compatibility factor. Patients with malignant tumor were divided into treatment group (33 cases of traditional Chinese medicine chemotherapy group) and control group (33 cases of simple chemotherapy group). The patients in the treatment group began to take oral Chinese medicine from the first time of chemotherapy, with Huangqi Guizhi Wuwu decoction as the main cut, which lasted until the end of six cycles of chemotherapy, while the control group was treated with simple chemotherapy. The data to be collected include peripheral neurotoxic symptoms after chemotherapy. The motor nerve conduction velocity (MNCVV) and sensory nerve conduction velocity (SCV) of each nerve before and after the first chemotherapy and the end of the six-cycle chemotherapy, as well as the safety indexes. Results the incidence of peripheral neurotoxic symptoms and signs in the treatment group was significantly lower than that in the control group, and the clinical manifestation was slightly higher than that in the control group (P 0.01). 2the motor nerve conduction velocity (MNCVV) decreased before and after chemotherapy. In the treatment group, the left ulnar nerve, the left peroneal nerve, the left median nerve and the right median nerve were significantly different. There was no statistical difference between the right ulnar nerve and the right peroneal nerve. In the control group, there were significant differences in left median nerve, right median nerve, left ulnar nerve and right ulnar nerve before and after chemotherapy. There was no statistical difference in the right peroneal nerve (P0.05). 3The motor nerve conduction velocity (MNCVV) after chemotherapy was significantly different between the right median nerve group (P 0.05). There was no statistical difference between the left ulnar nerve group and the left ulnar nerve group before and after chemotherapy. If the data of motor nerve were synthesised, there was no statistical difference before and after chemotherapy (P 0.05), but there was no significant difference between the groups after chemotherapy (P 0.05. 4) for sensory nerve conduction velocity (SCV). Before and after chemotherapy showed a downward trend, the comparison of each sensory nerve before and after chemotherapy were statistically different (P0.01). Conclusion: Huangqi Guizhi Wuwu decoction has significance in preventing and treating peripheral neurotoxicity induced by oxaliplatin chemotherapy. It can prevent the occurrence and aggravation of peripheral neurotoxicity in chemotherapy.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.53

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