中药消水方离子导入联合顺铂腹腔灌注治疗恶性腹水的临床观察

发布时间：2018-05-19 09:15

本文选题：恶性腹水 + 中药消水方离子导入　；参考：《安徽中医药大学》2017年硕士论文

【摘要】：目的:观察中药消水方离子导入联合顺铂腹腔灌注治疗恶性腹水的疗效,探讨中药消水方离子导入联合顺铂腹腔灌注的方法对于肿瘤患者的腹水量、腹围、24h尿量、腹水肿瘤指标、不良反应等方面的情况,以及提高生活质量的影响,为今后治疗恶性腹水的临床研究提供循证依据。方法:观察安徽省立医院中医肿瘤科2015年1月至2016年12月收治的恶性腹水患者,将符合纳入标准的45例患者按住院先后随机分为治疗组23人及对照组22人。治疗组采用中药消水方离子导入联合顺铂腹腔灌注治疗;对照组采用单纯顺铂腹腔灌注化疗,两周为一个疗程,两个疗程后评估患者腹水量、24小时尿量、腹围、腹水肿瘤指标、不良反应、临床症状及生活质量变化情况,应用统计学分析,得出最后的临床疗效。结果:1.腹水疗效指标:治疗组完全缓解2人,部分缓解17人,稳定3人,进展1人,有效率83%;对照组完全缓解2人,部分缓解7人,稳定5人,进展8人,有效率41%,两组有效率对比,治疗组高于对照组,c2=9.63,P0.05,两组具有明显的差异,提示采用本研究方法较单纯顺铂腹腔灌注疗效较突出。两组腹水患者在治疗前后B超定位下腹水均有所下降,治疗组治疗前腹水量为94.53±18.91mm,治疗后67.17±12.44mm;对照组治疗前89.91±20.28mm,治疗后79.09±23.45mm。经t检验分析后得出P0.05,两组在统计学上有明显差异,说明治疗组腹水消退较对照组明显。2.腹围:两组腹围在治疗后均有所降低,治疗组治疗前腹围为98.87±7.11cm,治疗后腹围为66±12.74cm;对照组腹围治疗前为106.91±13.01cm,治疗后腹围为90.86±10.97cm。两组治疗后经t检验得出P0.01,差异有统计学意义,结果提示治疗组腹围较对照组减少明显。3.24h尿量:两组尿量在治疗后均有不同程度的增加,治疗组治疗前尿量为361.30±125.02mL,治疗后尿量为723.48±163.81mL;对照组治疗前尿量为358.64±96.53mL,治疗后尿量为608.64±140.08mL。经统计学分析,t=2.52,P0.05,两组在尿量上存在明显的差异,结果提示治疗组治疗后尿量较对照组增加明显。4.腹水肿瘤指标:治疗组肿瘤指标降低8人,稳定13人,增加2人,改善率91%;对照组肿瘤指标降低3人,稳定10人,增加9人,改善率59%,经统计学分析,c2=6.32,P0.05,两组腹水指标具有统计学意义,治疗组较对照组腹水减少明显。5.临床症状变化情况:临床症状积分由腹胀、消瘦、饮食、睡眠四方面的相加组成。两组患者在治疗后症状均较前有所改善,治疗组治疗前为29.70±5.55,治疗后为20.40±3.70;对照组治疗前为27.05±5.67,治疗后为23.35±4.27。经统计学分析,t=2.48,P0.05,两组具有明显的差异,治疗组较对照组临床症状改善明显。6.生活质量变化情况:治疗组提高8人,稳定14人,降低1人,改善率96%;对照组提高4人,稳定12人,降低6人,改善率72%。经卡方检验分析,c2=7.68,P0.05,两组在统计学上存在明显差异,结果显示治疗组治疗前后生活质量明显高于对照组。两组KPS评分比较,治疗组升高7人,稳定14人,降低3人,改善率91%;对照组升高3人,稳定8人,降低11人,改善率50%,经卡方检验得出c2=7.73,P0.05,两组在统计学上有明显差异,治疗组较对照组生活质量提高。7.不良反应:两组患者在安全性方面无明显差异,仅有部分出现轻度骨髓抑制、皮疹、发热等不良反应,停药后不再出现。结论:1.采用中药消水方离子导入联合顺铂腹腔灌注的方法较单纯采用顺铂腹腔灌注化疗的方法治疗恶性腹水的疗效显著;2.中药消水方离子导入联合顺铂腹腔灌注组在饮食、睡眠、腹胀、消瘦等方面较对照组有所改善;3.中药消水方离子导入联合顺铂腹腔灌注组在腹围方面,与对照组相比降低明显;在尿量方面,较对照组增加明显;4.中药消水方离子导入联合顺铂腹腔灌注组在生活质量提高方面明显高于对照组;5.中药消水方离子导入联合顺铂腹腔灌注组在安全性方面,未出现明显的不良反应,且成本低,表现出较好的安全性及应用价值。
[Abstract]:Objective: To observe the effect of iiontophoresis and cisplatin intraperitoneal perfusion in the treatment of malignant ascites, and to explore the effect of the method of iiontophoresis combined with cisplatin intraperitoneal perfusion on the volume of ascites, abdominal circumference, 24h urine volume, ascites tumor index, adverse reaction and so on, as well as the effect of improving the quality of life. The clinical study of malignant ascites provides evidence-based evidence. Methods: the patients with malignant ascites from the Department of oncology of the Anhui Provincial Hospital from January 2015 to December 2016 were observed, and 45 patients were randomly divided into 23 patients and 22 control groups according to the admission criteria. The control group was treated with intraperitoneal perfusion. The control group was treated with simple cisplatin intraperitoneal perfusion chemotherapy, two weeks as a course of treatment. After two courses, the patients' ascites, 24 hours urine volume, abdominal circumference, ascites tumor index, adverse reaction, clinical symptoms and quality of life were changed, and the final clinical efficacy was obtained by statistical analysis. Results: 1. results were as follows: the curative effect index of 1. ascites: The treatment group completely relieved 2 people, partially relieved 17 people, stable 3 people, 1 people, and 83%. The control group was completely relieved of 2, partly relieved, 7, 5, 8, and 41%, two. The treatment group was higher than the control group, c2=9.63, P0.05, and two group had obvious differences, suggesting the use of this study method compared with simple cisplatin intraperitoneal irrigation. The abdominal water in the two groups of the two groups of abdominal water decreased before and after the treatment. The abdominal water of the treatment group was 94.53 + 18.91mm before treatment and 67.17 + 12.44mm after treatment. The control group was 89.91 + 20.28mm before treatment, and 79.09 + 23.45mm. after the treatment was analyzed by t test. The two groups were statistically significant differences, indicating the abdomen of the treatment group. The abdominal circumference of the two groups was lower than that in the control group. The abdominal circumference of the two groups decreased after treatment. The abdominal circumference of the treatment group was 98.87 + 7.11cm before treatment. The abdominal circumference was 66 + 12.74cm after treatment. The control group was 106.91 + 13.01cm before the abdominal circumference, and the abdominal circumference was 90.86 + 10.97cm. two after treatment. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant, the result was a statistical significance, the result was a statistical significance, the result was a statistical significance, the result hints that the difference was statistically significant, the result was a statistical significance, the result hints that the difference was statistically significant, the result was a statistical significance, the result was a statistical significance, the result Compared with the control group, the abdominal circumference of the treatment group decreased significantly.3.24h urine volume: the urine volume in the two groups increased in different degrees after treatment. The urine volume of the treatment group was 361.30 + 125.02mL before treatment, and the urine volume after treatment was 723.48 + 163.81mL; the urine volume of the control group was 358.64 + 96.53mL before treatment, and the post treatment urine volume was 608.64 + 140.08mL., t=2.52, P0.05, two groups. There was a significant difference in the urine volume. The results suggested that the urine volume of the treatment group was increased by.4. ascites tumor index in the treatment group: the tumor index of the treatment group was reduced by 8 people, 13 people were stable, 2 increased, the rate of improvement was 91%. The tumor index of the control group was 3, 10 stable, 9, and 59%, with statistical analysis, c2=6.32, P0.05, and two groups of ascites. The index had statistical significance, the treatment group compared with the control group, the ascites decreased significantly.5. clinical symptoms: the clinical symptom score was composed of four aspects of abdominal distention, emaciation, diet and sleep. The two groups were improved after treatment, 29.70 + 5.55 before treatment, 20.40 3.70 after treatment, and 2 in the control group before treatment. 7.05 + 5.67, after the treatment was 23.35 + 4.27. by statistical analysis, t=2.48, P0.05, two groups have obvious differences, compared with the control group, the clinical symptoms improved significantly.6. quality of life changes: the treatment group increased 8, the stability of 14 people, 1, the improvement rate 96%; the control group increased 4, 12 people, reduced 6, the improvement rate 72%. test score of the 72%. score Analysis, c2=7.68, P0.05, the two groups were statistically significant differences, the results showed that the quality of life in the treatment group was significantly higher than that of the control group. Compared with the two groups, the KPS score of the treatment group was 7, 14, 3, and 91%, and 3 in the control group, 8, 11, 50%, and c2=7.73, P0.05, two. There was significant difference in statistics. The quality of life in the treatment group was higher than that of the control group.7.. There was no significant difference in safety between the two groups. There were only some mild myelosuppression, rash, fever and other adverse reactions, and no longer appeared after the withdrawal. Conclusion: 1. the method of combining cisplatin combined with cisplatin was used. The effect of cisplatin intraperitoneal perfusion chemotherapy on malignant ascites was significantly better than that of the control group. 2. the iiontophoresis combined with cisplatin intraperitoneal perfusion group was better than the control group in the diet, sleep, abdominal distention and emaciation, and 3. the iiontophoresis combined with cisplatin intraperitoneal perfusion group in abdominal circumference, compared with the control group. Obviously, in the urine volume, it was more obvious than the control group; 4. the iiontophoresis combined with cisplatin intraperitoneal perfusion group was obviously higher than the control group. 5. the ionconium ion introduction combined with cisplatin intraperitoneal perfusion group had no obvious adverse reaction in the safety of the cisplatin intraperitoneal perfusion group, and the cost was low, and it showed good safety. And application value.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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