本文關鍵詞：穴位埋線防治乳腺癌術后化療不良反應的臨床研究　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 穴位埋線 乳腺癌術后 化療不良反應

【摘要】：乳腺癌(Breast cancer)是由乳腺導管上皮發(fā)生的惡性腫瘤。受人口老年化和生活方式改變的影響,我國乳腺癌的發(fā)病率呈低齡化趨勢。據(jù)2015年全國腫瘤登記處的數(shù)據(jù)統(tǒng)計,中國大約有27萬人次發(fā)病,約7萬次人死于乳腺癌。目前,除了以手術與放療為主的局部治療方式外,局部與全身相結合的新型治療方式,如化療、內(nèi)分泌治療及中醫(yī)藥治療等,被廣泛應用于臨床。其中化療作為乳腺癌術后輔助治療的三大重要手段,可一定程度降低患者的病死率,發(fā)揮著不可替代的作用。但化療引起的一系列不良反應,包括消化道不良反應(如食欲減退、惡心嘔吐、腹瀉腹痛或便秘等)和骨髓抑制(如全血細胞降低,以白細胞下降最明顯),嚴重影響患者的精神狀態(tài),阻礙治療進程,影響臨床療效。因此,乳腺癌術后化療引起的不良反應是目前乳腺癌術后臨床研究的重點之一。有學者認為,中醫(yī)藥治療乳腺癌術后化療引起的不良反應療效顯著,其中穴位埋線療法以其刺激作用持久、間隔時間長、操作簡便、成本低廉的特色,成為近年來研究和探討的熱點。故本研究選用穴位埋線防治乳腺癌術后化療的不良反應,以期進一步改善患者的生存質(zhì)量,提高臨床療效。目的:采用穴位埋線防治乳腺癌術后化療引起的不良反應,并與單純西藥常規(guī)治療相對比,以進一步改善患者的生存質(zhì)量,提高臨床療效,為穴位埋線防治乳腺癌術后化療不良反應提供重要的科學依據(jù)。方法:將符合診斷、納入及排除標準的乳腺癌術后化療患者,按隨機數(shù)字表的方法,分為治療組(即穴位埋線+西藥常規(guī))30例和對照組(即西藥常規(guī))28例。對照組予常規(guī)止嘔治療,必要時予升白細胞及抗感染治療。治療組在對照組的基礎上加予穴位埋線。第一組選穴:中脘、氣海、胃俞(雙)、腎俞(雙)、足三里(雙);第二組選穴:天樞(雙)、關元、大椎、脾俞(雙)、上巨虛(雙)。兩組穴位交替進行。分別記錄第1~4個化療周期后兩組患者有無食欲減退、惡心嘔吐、腹瀉和便秘,化療后第9d白細胞計數(shù)變化情況,以及血小板計數(shù)和血紅蛋白下降程度(陽性率)。若所有數(shù)據(jù)符合正態(tài)分布,則以(均數(shù)土標準差)的形式表現(xiàn),計量資料采用t檢驗,計數(shù)資料采用χ2檢驗,假設檢驗統(tǒng)一使用雙側檢驗,得出檢驗統(tǒng)計量及其對應的P值,若P0.05則有統(tǒng)計學意義。對于非正態(tài)分布數(shù)據(jù),經(jīng)對數(shù)轉(zhuǎn)換后再分析。所有數(shù)據(jù)均采用SPSS 20.0進行分析數(shù)據(jù)。結果:1.治療組和對照組的一般資料,如年齡、病程、白細胞計數(shù)、TNM臨床分期等,經(jīng)統(tǒng)計分析無顯著性差異(P0.05),具有可比性。2.經(jīng)穴位埋線治療后,治療組在第1~4個化療周期后的消化道不良反應(包括食欲減退、惡心嘔吐、腹瀉和便秘)較對照組均明顯減少(P0.05);3.治療組在每次化療后第9d白細胞計數(shù)下降情況較對照組減少減輕(P0.05);治療組在4個化療周期內(nèi),應用重組人粒細胞集落刺激因子的情況較對照組少(P0.05),而應用抗生素的情況,兩組比較無顯著差異(P0.05)。4.治療組在第1個化療周期后第9d血小板計數(shù)下降程度(陽性率)方面較對照組,差異無統(tǒng)計學意義(P0.05),主要考慮血小板代謝時間較長,故在第1個化療周期后治療組較對照組無明顯減輕;在第2~4個化療周期后第9d血小板計數(shù)下降程度(陽性率)方面,對照組與治療組相比下降明顯(P0.05)。5.治療組在第1個化療周期后第9d血紅蛋白下降程度(陽性率)方面較對照組,差異無統(tǒng)計學意義(P0.05),主要考慮血紅蛋白代謝時間較長,故在第1個化療周期后治療組較對照組無明顯減輕;在第2~4個化療周期后第9d血紅蛋白下降程度(陽性率)方面,對照組與治療組相比下降明顯(P0.05)。結論:穴位埋線能有效減輕乳腺癌術后化療引起的不良反應,治療組在食欲減退、惡心嘔吐、腹瀉和便秘等消化道不良反應方面較對照組明顯減輕;白細胞計數(shù)下降情況較對照組顯著減少;血小板計數(shù)和血紅蛋白下降程度方面,對照組與治療組相比下降明顯。研究表明,穴位埋線可有效提高自身機體免疫,保護造血機能,調(diào)節(jié)胃腸功能,降低化療引起的不良反應,提高患者的生存質(zhì)量,且該療法經(jīng)濟安全、簡便有效,值得進一步臨床研究和推廣。
[Abstract]:Breast cancer (Breast cancer) is produced by the breast ductal cancer. Affected by the aging population and lifestyle changes, the incidence of breast cancer in China showed a trend of younger age. According to the 2015 National Cancer Registry data statistics, about 270 thousand people China disease, about 70 thousand people died of breast cancer. At present, in addition to local treatment with surgery and radiotherapy, new therapeutic approaches, the combination of local and systemic chemotherapy, endocrine therapy and traditional Chinese medicine treatment, has been widely used in clinic. The chemotherapy for postoperative breast cancer auxiliary three important means of treatment, can reduce the mortality of the patients with a certain degree rate, plays an irreplaceable role. But a series of adverse reactions caused by chemotherapy, including gastrointestinal adverse reactions (such as anorexia, nausea and vomiting, abdominal pain, diarrhea or constipation) and bone marrow suppression (such as blood cell drop Low to white blood cells decreased most obviously), seriously affect the patient's mental state, hinder the treatment process, the clinical therapeutic effect. Therefore, the adverse reactions caused by chemotherapy after breast cancer surgery is currently the postoperative breast cancer clinical research focus. Some scholars believe that the adverse reaction caused by chemotherapy efficacy of traditional Chinese medicine in the treatment of breast cancer patients after significant, the catgut embedding therapy for its stimulating effect lasting, long time interval, simple operation, low cost characteristics, become a research hotspot in recent years and discuss the adverse reaction. So this study selected acupoint catgut embedding for breast cancer prevention and treatment of postoperative chemotherapy, in order to further improve the quality of life of patients, improve the curative effect. Objective: adverse reactions caused by chemotherapy for breast cancer prevention and treatment by acupoint catgut embedding therapy after operation, and compared with the conventional treatment of Western medicine alone, to further improve the quality of life of patients, improve the clinical efficacy, to the point Provide an important scientific basis for prevention and treatment of adverse reaction of chemotherapy catgut embedding therapy after breast cancer surgery. Methods: according to the diagnosis, inclusion and exclusion criteria of the breast cancer patients with postoperative chemotherapy, according to the random number table method, divided into the treatment group (i.e. conventional western medicine + acupoint catgut embedding) 30 cases and the control group (i.e. conventional Western Medicine) 28 cases the control group received routine antiemetic treatment, when necessary to increase white blood cell and anti infection treatment. The treatment group on the basis of control group. The first group was treated with acupoint catgut embedding choose Zhongwan, Qihai, Weishu (double) and Shenshu (double), Zusanli (double); second groups of acupoints: Tianshu (double), Guan yuan, Dazhui, Pishu (double), Shangjuxu (double). The two groups were recorded. The alternating points 1~4 cycles after two groups of patients with and without loss of appetite, nausea and vomiting, diarrhea and constipation, changes in 9D white blood cell count and platelet count and after chemotherapy. Hemoglobin decreased (positive rate). If all the data to conform to normal distribution, with (mean + standard deviation) of the form, measurement data using t test, count data using chi square test 2, unified hypothesis testing using two-sided test, the test statistic and its corresponding P value, if P0.05 had statistical significance. For the non normal distribution of data. After log transformation analysis. All the data were analyzed by means of SPSS 20 data. Results: the general data, 1. treatment group and control group, such as age, course of disease, white blood cell count, TNM clinical stage, there were no statistically significant differences (P0.05), comparable to.2. by acupoint catgut embedding therapy after treatment gastrointestinal adverse reactions, the treatment group in the first 1~4 after the chemotherapy cycle (including loss of appetite, nausea and vomiting, diarrhea and constipation) were significantly reduced compared with the control group (P0.05); 3. in the treatment group at 9D after chemotherapy the white blood cell count decreased compared with the control group decreased Reduce (P0.05); the treatment group in the 4 cycle of chemotherapy, the application of recombinant human granulocyte colony-stimulating factor of less than that of the control group (P0.05), and the application of antibiotics, the two groups had no significant difference (P0.05).4. treatment group in the first cycle of chemotherapy and 9D after platelet count decreased (the positive rate of) than the control group, the difference was not statistically significant (P0.05), the main consideration of platelet metabolism over a long period of time, the first cycle of chemotherapy after the treatment group than in control group significantly reduced; in the first 2~4 cycle of chemotherapy and 9D after platelet count decreased (positive rate), the control group compared with treatment group (P0.05).5. decreased significantly in the treatment group 9D after first cycles of chemotherapy hemoglobin decline degree (positive rate) than the control group, the difference was not statistically significant (P0.05), the main consideration of hemoglobin metabolism between the longer, so in first cycles after treatment group Compared with the control group decreased; in the first 2~4 cycles of chemotherapy after 9D hemoglobin decline degree (positive rate), the control group compared with treatment group decreased significantly (P0.05). Conclusion: catgut implantation can effectively reduce the adverse reactions caused by chemotherapy after breast cancer surgery, in the treatment group were anorexia, nausea and vomiting, diarrhea and constipation and other gastrointestinal adverse reactions than the control group significantly reduced; white blood cell count decreased significantly compared with the control group decreased; platelet count and hemoglobin decreased, compared with the control group and the treatment group decreased significantly. The results show that acupoint catgut embedding therapy can effectively improve their immunity, protect hematopoietic function, regulate gastrointestinal function, reduce the adverse the reaction caused by chemotherapy, improve the quality of life of patients, and the therapy is simple and effective, economic and safe, worthy of further clinical study and promotion.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.5
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本文編號：1377719