温阳逐水膏外敷治疗恶性腹腔积液的临床研究

发布时间：2018-10-20 12:48

【摘要】：研究目的：以温阳逐水膏外敷联合常规放腹水后药物灌注治疗对恶性腹水进行疗效观察,并与单纯常规放腹水后药物灌注治疗进行比较,观察两组治疗后对恶性腹水的临床疗效、对患者生活质量的影响、并观察对肿瘤标志物及血清VEGF变化,从而初步探讨温阳逐水膏外治方的作用机理,进而为中药外治法治疗恶性腹水提供客观依据。研究方法：将60例恶性腹水患者,随机分为两组,每组30例,一组为治疗组(以温阳逐水膏外敷联合常规放腹水后药物灌注治疗),另一组为对照组(单纯放腹水后药物灌注治疗)。治疗方法：对照组常规放腹水(腹腔穿刺后放腹水治疗,首次放腹水不超过1000ml,以后通过微导管每次放腹水不超过2000ml),经放腹水治疗,在腹水明显减少的基础上,以香菇多糖4mg、白介素-2300万单位联合腹腔灌注,每周2次,2周为一疗程。治疗组在上述治疗和用药基础上,避开穿刺点处外敷温阳逐水膏,按20mg/kg体重给药,涂药范围为上至剑突下,下至脐下10cm,在腹壁上保留24小时,隔日一次,共2周为一疗程。疗程结束后进行两组疗效比较,观察治疗后两组腹水的变化及生活质量方面的影响,并观察对肿瘤标志物与血清VEGF的变化。研究结果：温阳逐水膏组总有效率达80.0%,单纯常规放腹水组总有效率为56.7%；腹水最大液平直径温阳逐水膏组减少4.23cm,单纯放腹水组减少3.13cm,组间差异有统计学意义(p0.05)；治疗后两组病人均不同程度腹胀减轻,排气增多,纳食增加,小便量增多,生活质量得到改善,中医症候积分值经统计分析,治疗组优于对照组；经治疗后两组患者卡氏评分比较,差异显著：治疗组优于对照组；治疗后CA199、VEGF值较治疗前降低,温阳逐水膏组较单纯常规放腹水组更明显,差异有统计学意义；两组对血液、肝肾功能及心脏功能均无明显影响,且治疗组还能一定程度纠正贫血及改善肝功能；对不良反应的发生情况分析治疗组发生率低于对照组,从而表明治疗组与对照组比较疗效更突出,且安全性高,无明显不良反应。研究结论：温阳逐水膏外敷联合常规放腹水后药物灌注治疗恶性腹水是有效的,在减轻临床症状及体征、改善患者生活质量以及对肿瘤标志物、VEGF的影响方面优势更明显；相对于对照组,未增加毒副作用。因此,在常规治疗的基础上联合外敷温阳逐水膏可作为临床上治疗治疗恶性腹水的有效手段。温阳逐水膏外敷治疗恶性腹水,操作简单方便,且安全可靠,疗效确切,值得进一步推广应用。
[Abstract]:Objective: to observe the therapeutic effect of Wenyang Zhushui ointment combined with routine post-ascites infusion therapy on malignant ascites and compare it with that of simple routine post-ascites infusion therapy. To observe the clinical effect and quality of life of patients with malignant ascites after treatment, and to observe the changes of tumor markers and serum VEGF, so as to explore the mechanism of Wenyang Zhushui ointment for external treatment. It provides objective basis for external treatment of malignant ascites with traditional Chinese medicine. Methods: sixty patients with malignant ascites were randomly divided into two groups, 30 patients in each group. One group was treated with Wenyang Zhushui ointment and the other was control group. Treatment method: the control group was treated with routine ascites (ascites were not more than 1000ml for the first time and 2000ml for each time by microcatheter). Lentinus edodes polysaccharides 4 mg, interleukin-23 million units combined intraperitoneal perfusion, twice a week, 2 weeks as a course of treatment. On the basis of the above treatment and medication, the treatment group was given according to the body weight of 20mg/kg by avoiding the application of Wenyang Shuishui ointment at the puncture point. The range of application was up to 10 cm under the xiphoid process and down to the subumbilical layer, and it was kept on the abdominal wall for 24 hours, once every other day, for a course of treatment for 2 weeks. The changes of ascites and quality of life in the two groups were observed after the treatment, and the changes of tumor markers and serum VEGF were observed. The results showed that the total effective rate of Wenyang Zhushui ointment group was 80.0, the total effective rate of simple routine ascites group was 56.7, the maximum fluid level of ascites was 4.23 cm, and that of simple ascites group was 3.13 cm, the difference between groups was statistically significant (p0.05). After treatment, the abdominal distension, exhaust, food intake, urine volume and quality of life were improved in both groups. The integral value of TCM symptom was better than that of the control group after statistical analysis. After treatment, there were significant differences between the two groups: the treatment group was superior to the control group, the CA199,VEGF value of the treatment group was lower than that of the pre-treatment group, and the difference between the two groups was more obvious than that of the simple routine ascites group, and the difference between the two groups was statistically significant. The incidence of adverse reactions in treatment group was lower than that in control group, and the incidence of adverse reactions in treatment group was lower than that in control group. The results showed that the treatment group was more effective than the control group, with high safety and no obvious adverse reactions. Conclusion: it is effective to treat malignant ascites with external application of Wenyang Zhushui ointment combined with routine ascites infusion. It has more advantages in relieving clinical symptoms and signs, improving patients' quality of life, and influencing tumor markers and VEGF. Compared with the control group, no side effects were increased. Therefore, combined application of Wenyang Zhushui ointment on the basis of routine treatment can be used as an effective method for the treatment of malignant ascites. The treatment of malignant ascites with Wenyang Zhushui ointment is simple and convenient, safe and reliable, and worthy of further application.
【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】：2016
【分类号】：R730.5

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