刺络拔罐治疗乳腺癌术后上肢水肿的临床疗效观察

发布时间：2018-06-26 20:51

本文选题：刺络拔罐 + 临床治疗　；参考：《北京中医药大学》2016年硕士论文

【摘要】：目的客观评价刺络拔罐治疗乳腺癌术后上肢淋巴水肿的临床疗效,为乳腺癌术后淋巴水肿患者提供一个方便可靠的中医治疗方案,为刺络拔罐治疗乳腺癌术后上肢水肿的规范化操作提供技术支持。方法将75例乳腺癌术后上肢水肿患者随机分为两组,其中对照组25例,治疗组50例；治疗组给予刺络拔罐,同时行上肢功能锻炼操,刺络拔罐的部位选择为患侧上肢手三阴经和手三阳经,每次治疗选取1-2条经络,沿此经络在皮下结节处、最肿胀部位梅花针点刺出血后拔火罐；同时循背部双侧膀胱经闪罐两遍后,选取肺俞穴及脾俞穴点刺出血后拔火罐,沿膀胱经其它部位仅拔罐不点刺出血,每个部位留罐10分钟；对照组单纯行上肢功能锻炼操。两组治疗周期均为50天,上肢功能锻炼操每天进行,每次30分钟,治疗组刺络拔罐5天行一次治疗,共进行10次治疗。主要疗效评价指标为患肢臂围变化,5次访视分别记录患侧上肢腕横纹、腕上lOcm、肘横纹、肘上l0cm处的臂围,将两组治疗前后的臂围平均值及差值进行分析对比；次要疗效评价指标包括有效指数、肩关节活动度、疼痛评分、患肢肌力分级、生活质量评分及安全性评价。所有研究数据及结果均采用SPSS20.0统计软件进行计算分析,若P0.05则认为差异有统计学意义。结果通过50天的临床疗效观察,治疗后两组臂围的均值及差值P0.05,差异具有统计学意义,其中治疗组臂围平均减小1.21cm,对照组臂围平均减小0.58cm,治疗组的疗效明显优于对照组；患肢腕横纹处及腕横纹上l0cm处,组间比较其均值及差值具有统计学意义,治疗组在此两点处的臂围缩小较对照组明显；治疗组与对照组的总有效率分别为95.8%和58.3%；在改善肩关节功能活动方面,组间比较P0.05,两组之间无差异；但是两组治疗前后的组内比较,四个角度的活动均有所改善,差异具有统计学意义；在改善疼痛方面,组内比较P0.05,两组患者治疗后疼痛均较治疗前减轻,组间比较P0.05,治疗组优于对照组；在生活质量方面,比较治疗组与对照组治疗后QOL总分,得出P0.05,差异具有统计学意义,说明在提高患者生活质量方面,治疗组明显优于对照组,而生活质量的提高具体表现在“改善睡眠”、“缓解疲乏”“减轻疼痛”三个方面；安全评价方面,两组患者均未出现不良事件。结论刺络拔罐法可有效减轻患肢水肿,尤其对前臂水肿的消退有较突出的疗效；刺络拔罐可以改善肩关节活动度,能更有效的缓解上肢淋巴水肿所引起的肢体疼痛,同时可以改善睡眠,缓解疲乏从而提高乳腺癌术后上肢水肿患者的生活质量,并且刺络拔罐法操作简便、费用低廉、安全性高,易于被患者接受,是一种值得在临床上推广应用的治疗乳腺癌术后上肢水肿的可靠方案。
[Abstract]:Objective to evaluate objectively the clinical effect of pricking and cupping on upper limb lymphedema after operation of breast cancer, and to provide a convenient and reliable Chinese medicine treatment scheme for postoperative lymphedema patients of breast cancer. To provide technical support for standardized operation of pricking and cupping for upper limb edema after breast cancer operation. Methods Seventy-five patients with upper limb edema after breast cancer operation were randomly divided into two groups: the control group (n = 25) and the treatment group (n = 50). The position of pricking and cupping was selected as three yin meridians and three yang meridians of the affected upper limbs. 1-2 meridians were selected for each treatment, along which the meridians were placed at the subcutaneous nodule, and the most swollen part was pricked with plum needle to prick the cupping. At the same time, the cupping of both sides of the bladder was followed twice, and the cupping was taken out after pricking and bleeding at the points of Feshu and Peshu, and only the cupping was not punctured along the other parts of the bladder, and the cupping was kept in each part for 10 minutes, while in the control group, the function of upper limbs was exercised only. The treatment period of the two groups was 50 days. The upper limb functional exercise was performed every day for 30 minutes. The treatment group was treated once for 5 days and 10 times. The main outcome indexes were as follows: the changes of arm circumference of the affected limbs were recorded by 5 visits. The transverse striae of wrist, lOcm on wrist, transverse striae of elbow and arm circumference of l0cm on elbow were recorded respectively. The mean value and difference of arm circumference before and after treatment were analyzed and compared between the two groups. Secondary efficacy indicators included effectiveness index, shoulder motion, pain score, muscle strength grading of affected limbs, quality of life score and safety evaluation. All the data and results were calculated and analyzed by SPSS 20.0 statistical software. If P0.05, the difference was statistically significant. Results after 50 days of treatment, the mean value and difference of arm circumference were significantly different between the two groups (P 0.05). The average arm circumference of the treatment group decreased 1.21 cm, and the average arm circumference of the control group decreased 0.58 cm. The curative effect of the treatment group was significantly better than that of the control group. The mean value and difference between the two groups were statistically significant, and the total effective rates of the treatment group and the control group were 95.8% and 58.3%, respectively, and the reduction of the arm circumference between the two groups was more obvious than that in the control group, and the total effective rates of the treatment group and the control group were 95.8% and 58.3%, respectively. In terms of improving the functional activity of shoulder joint, there was no difference between the two groups in terms of P0.05, but the activity of four angles was improved in both groups before and after treatment, and the difference was statistically significant. Compared with P0.05, the pain of the two groups after treatment was less than that before treatment, the comparison between the two groups was P0.05, the treatment group was better than the control group, in terms of quality of life, the total score of QOL after treatment was compared between the treatment group and the control group, and the difference was statistically significant. It shows that the treatment group is obviously superior to the control group in improving the quality of life of the patients, and the improvement of the quality of life is manifested in three aspects: "improving sleep", "relieving fatigue" and "relieving pain"; There were no adverse events in both groups. Conclusion the method of pricking and cupping can effectively reduce the edema of the affected limb, especially the abatement of the edema of the forearm, and the pricking and cupping can improve the motion of the shoulder joint and relieve the limb pain caused by lymphedema of the upper limb more effectively. At the same time, it can improve sleep, relieve fatigue and improve the quality of life of patients with edema of upper extremity after breast cancer operation, and the method of puncture and cupping is easy to operate, low cost, high safety and easy to be accepted by patients. It is a reliable method for the treatment of upper limb edema after breast cancer surgery.
【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】：R246.5

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