益气养阴、凉血散瘀法干预食管癌放疗期间毒副反应的临床研究

发布时间：2018-02-24 07:15

  本文关键词： 益气养阴 凉血散瘀 放疗 食管癌 毒副反应　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：本课题基于周仲瑛教授“瘀热”理论指导和导师吴勉华教授的临床经验基础,运用益气养阴、凉血散瘀的治法,拟定食管癌放疗期间常用中药处方加减,联合放疗治疗食管癌,客观评价中医药在干预食管癌放疗期间毒副反应的临床疗效。方法：将符合纳入标准的60例患者,按随机对照的研究方法分为治疗组和对照组各30例,最终收集病例数为两组各29例。对照组给予单纯放疗方案治疗,治疗组在放疗基础上口服以“益气养阴、凉血散瘀”法拟定的中药处方,每日1剂,早晚2次分服。观察从放疗开始日起,至放疗结束1周止。比较两组在中医症状、放射性食管炎、骨髓抑制、KPS体力状况以及体重之间的差别。全部数据采用SPSS19.0进行统计学分析。结果：①中医症候改善比较：治疗组患者进食梗阻,吞咽疼痛,倦怠乏力,大便干结治疗前后较对照组相比,有统计学意义(P0.05),而口干欲饮,自觉发热治疗前后较对照组相比无明显差异,无统计学意义(P0.05)；②放射性食管炎比较：两组患者均不同程度地出现了放射性食管炎,两组患者放射性食管炎的发生率治疗组为85.2%,对照组为100%。两组患者放射性食管炎分级比较方面,治疗组发生2级及以上食管炎的发生率为38%,对照组为73%,两组比较差异具有显著统计学意义(P0.05)；③骨髓抑制比较：治疗组出现骨髓抑制0度14例,Ⅰ度8例,Ⅱ度6例,Ⅲ度1例,总发生率为52%,对照组出现骨髓移植0度4例,Ⅰ度12例,Ⅱ度11例,Ⅲ度2例总发生率为86%,两组经统计学处理卡方检验(P0.05),有统计学意义；④KPS体力状况比较：治疗组放疗前后体力增强和稳定的共有25例(86.2%),而对照组为16例(55.2%),治疗组放疗后体力状况下降的有4例(13.8%),而对照组为13例(44.8%),两组比较经卡方检验,X2=6.685,P=0.04(P0.05),两组比较差异有统计学意义;⑤体重比较：治疗组放疗前后体重改变共有23例(79.3%),而对照组为18例(62%),治疗组放疗后体重改变下降的有7例(24.1%),而对照组为11例(37.9%)两组比较经卡方检验,X2=2.219,P=0.364(P0.05),两组比较差异无统计学意义。结论：益气养阴、凉血散瘀法能改善食管癌患者放疗期间中医症候,尤其在改善进食梗阻、吞咽疼痛、大便干结、倦怠乏力方面。减轻放射性食管炎、骨髓抑制发生率及严重程度,提高患者生存质量,但在体重变化方面两者没有显著差异。
[Abstract]:Objective: based on the theoretical guidance of Professor Zhou Zhongying's "blood stasis heat" and the clinical experience of professor Wu Menghua, and using the methods of supplementing qi and nourishing yin, cooling blood and dissipating blood stasis, the author worked out the addition and subtraction of traditional Chinese medicine for esophageal cancer during radiotherapy. To evaluate objectively the clinical efficacy of traditional Chinese medicine (TCM) in the treatment of esophageal carcinoma during radiotherapy. Methods: 60 patients who met the criteria were divided into two groups according to the randomized control study: 30 cases in the treatment group and 30 cases in the control group. The final number of cases was 29 cases in each group. The control group was treated with radiotherapy alone, while the treatment group was treated with traditional Chinese medicine prescription of "replenishing Qi and nourishing Yin, cooling blood and dissipating stasis" on the basis of radiotherapy, 1 dose per day. Take it twice in the morning and evening. Observe from the beginning of radiotherapy to the end of 1 week of radiotherapy. Compare the two groups in TCM symptoms, radiation esophagitis, All data were analyzed statistically by SPSS19.0. Results the improvement of TCM symptoms in the treatment group: eating obstruction, dysphagia pain, burnout and fatigue. Compared with the control group before and after treatment, there was no significant difference between the control group and the control group before and after treatment, but there was no significant difference between the control group and the control group before and after treatment, while there was no significant difference between the two groups before and after the treatment. Comparison of radiation esophagitis between the two groups: the incidence of radiation esophagitis was 85.2in the treatment group and 100 in the control group. The incidence of grade 2 and above esophagitis in the treatment group was 38 and that in the control group was 73. The difference between the two groups was statistically significant (P 0.05). There were 14 cases of bone marrow depression of 0 degree, 8 cases of grade 鈪，

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