基于大气下陷理论治疗非小细胞肺癌术后相关症状的研究

发布时间：2018-12-15 02:33

【摘要】：研究目的：研究非小细胞肺癌(NSCLC)患者术后症状的分布规律,并探讨以大气下陷理论为基础的升陷汤辨证加减治疗NSCLC术后相关症状的疗效及作用特点。研究方法：通过门诊收集病人,具体入组条件如下：1.符合NSCLC诊断标准,已行手术治疗；2.首次就诊时间为术后半年后,且未经治疗(包括放化疗、生物治疗以及中医治疗等)；3.年龄：18-70周岁；4.没有合并其他心血管、肺以及肾等严重病证。纳入肺癌患者术后常见症状,以《中药新药临床研究指导原则》的症状评价标准制定肺癌术后症状观察量表,生活质量评价采用EORTC QLQLC13版-生活质量量表。中医治疗以大气下陷理论为基础,以升陷汤(生黄芪、知母、升麻、桔梗、柴胡)为基本方辨证加减化裁,偏痰湿证的患者合二陈汤(陈皮、半夏、茯苓等)加减治疗,兼血瘀表现的患者合血府逐瘀汤(川芎、当归、赤芍、红花、丹参、桃仁等)加减治疗,同时辅以解毒抗癌药如白英、僵蚕、白花蛇舌草等。治疗疗程为1个月,每日一剂,早晚两次分服,评价治疗前后患者的不适症状以及生活质量改善情况。研究结果：剔除不合格的患者,最后共入组48例,结果如下：1.NSCLC术后患者症状分布规律：患者术后常见的症状有气短、乏力、自汗、咳嗽、胸闷等。通过对于入组前患者症状调查显示：术后第1月,气短患者占100%,神疲乏力患者占89.6%,咳嗽患者占91.7%,自汗患者占70.8%,胸闷患者占70.8%；术后第2月,气短患者占97.9%,神疲乏力患者占89.6%,咳嗽患者占66.7%,自汗患者占66.7%,胸闷患者占54.2%；术后第3月,气短患者占93.75%,神疲乏力患者占89.6%,咳嗽患者占66.7%,自汗患者占62.5%,胸闷患者占54.2%；术后第4月,气短患者占93.75%,神疲乏力患者占89.6%,咳嗽患者占66.7%,自汗患者占62.5%,胸闷患者占54.2%。患者术后不适症状平均评分在术后第2月开始趋于稳定状态,术后第1月平均评分19.65,术后第2月平均评分15.88,术后第3月平均评分15.56,术后第4月平均评分15.63。即患者在术后两个月内,不适症状可以通过饮食调摄、锻炼等得到一定的恢复,但是无法完全缓解。如术后气短、神疲乏力、胸闷等症状在术后第3、4月仍是影响患者康复的重要症状。2.基于大气下陷理论的升陷汤辨证加减治疗对NSCLC术后症状改善以及生活质量的影响：升陷汤辨证加减治疗后,气短(治疗前平均分2.36±0.33,治疗后平均分1.27±0.36,p0.01)、乏力(治疗前评分2.31±0.39,治疗后评分1.23±0.43,p=0.04)、咳嗽(治疗前平均分1.44±0.15,治疗后平均分0.81±0.19,p=0.03)等症状显著改善。生活质量量表评价显示：治疗后可显著改善NSCLC术后患者的躯体功能(有效率95.8%)、角色功能(有效率87.5%)、情绪功能(有效率98%)、社会功能(有效率100%)以及总健康状况水平(有效率100%),提高了患者的生活质量。研究结论：1.NSCLC术后的患者以大气下陷所导致的心肺功能异常症状为主要表现。术后患者的自我恢复功能可以部分缓解不适症状,但在术后两个月以后仍有气短、乏力等不适症状,严重影响患者的生活质量。2.基于大气下陷理论为基础的升陷汤辨证加减治疗NSCLC术后患者,可有效改善NSCLC患者的不适症状,其中气短、乏力、咳嗽、胸闷、口干等症状,治疗后症状评分显著下降,同时可显著提高患者的生活质量,尤其对于躯体功能、社会功能的改善比较显著,值得今后临床进一步推广研究。
[Abstract]:Objective: To study the distribution of postoperative symptoms in patients with non-small cell lung cancer (NSCLC), and to explore the effect and effect of the treatment of the related symptoms of NSCLC after the treatment of NSCLC. Methods: The patients were collected through the clinic. The specific conditions of the group were as follows: 1. in accordance with that diagnostic criteria for NSCLC, the surgical treatment was performed; 2. The first time of the visit was six months after the operation and was not treated (including chemoradiotherapy, biological treatment, and treatment of traditional Chinese medicine); 3. Age: 18-70 years old; 4. No other serious diseases such as cardiovascular, lung, and kidney were combined. The postoperative common symptoms of patients with lung cancer were included, and the postoperative symptom observation scale of lung cancer was developed with the symptom evaluation criteria of the Guidelines for Clinical Study of the New Drug for Traditional Chinese Medicine. The quality of life was evaluated by the EORTC QLQLQLC13-Quality of Life Scale. The traditional Chinese medicine treatment is based on the theory of atmospheric sags, and is treated with the addition and subtraction of the decoction (raw yellow rice, rhizoma anemarrhenae, cimicifugae, Radix Platycodi, and Bupleuri) as the basic prescription, and the patients with the syndrome of reducing phlegm and dampness are combined with the two-in-one decoction (Chen Pi, Pinellia ternata, Poria, etc.). and can be used as a detoxification anticancer medicine such as white English, Bombyx Batryticatus, and Herba Hedyotidis Diffusae. The treatment course was 1 month, once a day, twice daily, and the symptoms of discomfort and the quality of life of the patients before and after treatment were evaluated. The results of the study were as follow: 1. The common symptoms of the patients after operation were short, weak, spontaneous sweating, cough, chest distress and so on. In the first month after the operation, the patients accounted for 100% of the patients with shortness of breath, 89.6% of the patients with fatigue, 91.7% of the patients with cough, 70.8% of the patients with spontaneous perspiration, and 70.8% of the patients with chest distress. The patients with the shortness of breath in the second month after the operation accounted for 92.9% and 89.6% of the patients with fatigue. The patients with cough (66. 7%), spontaneous perspiration (66. 7%) and chest distress (54. 2%). In the third month of the operation, the patients with shortness of breath (90.75%), the patients with fatigue and fatigue (89.6%), cough (66. 7%), spontaneous perspiration (62.5%) and chest distress (54.2%), the patients with shortness of breath (90.75%). The patients with fatigue and fatigue accounted for 89.6%, 65.7% of the patients with cough, 62.5% of the patients with spontaneous perspiration and 54.2% of the patients with chest distress. The mean score of discomfort after operation was stable in the second month of the operation, the mean score of the first month after the operation was 19.65, the mean score of the second month was 15.88, the mean score of the third month after the operation was 15.56, and the mean score of the fourth month was 15.63. That is, in two months after the operation, the discomfort of the patient can be recovered by diet, exercise, etc., but the patient can't complete the complete remission. such as short-term postoperative short breath, listlessness, chest distress and other symptoms, is still an important symptom of the patient's rehabilitation after the third and fourth months of the operation. The effect of the treatment on the improvement of the symptoms and the quality of life of the patients with NSCLC after the treatment of the syndrome of the ascending and descending decoction on the basis of the theory of atmospheric sags: after the treatment of the syndrome differentiation and the addition and subtraction of the decoction, the average score was 2.36 and 0.33, the mean score of the treatment was 1.27 (0.36, p0.01), and the level of weakness (the pre-treatment score of 2.31. 0. 39, After the treatment, the scores were 1. 23 (0.43, p = 0.04), and the cough (the mean score of 1.44 and 0.15, the mean score of 0.81, 0.19, p = 0.03) was significantly improved after the treatment. The evaluation of the quality of life scale shows that after the treatment, the body function (effective rate of 95.8%), the role function (the effective rate of 85.7%), the emotional function (the effective rate of 98%), the social function (the effective rate of 100%) and the general health status (the effective rate of 100%) can be significantly improved after the treatment. and the quality of life of the patient is improved. The results of the study were as follows: 1. The patients with NSCLC were mainly characterized by the abnormal condition of the cardiopulmonary function caused by the atmospheric sags. The self-recovery function of the post-operative patients can relieve the discomfort of the patient, but the patient still has the symptoms of short breath and weakness after two months after the operation, which seriously affects the quality of life of the patient. On the basis of the theory of atmospheric sag, the treatment of patients with NSCLC after the treatment of NSCLC can be effectively improved, and the symptoms such as short breath, asthenia, cough, chest distress, dry mouth and the like can be effectively improved, the symptom score after treatment is obviously reduced, and the quality of life of the patients can be obviously improved, in particular to that function of the body, the improvement of the social function is remarkable, and the research is worth further popularization in the future.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

【相似文献】