本文關(guān)鍵詞：加味仙方活命飲外用治療卡培他濱所致手足綜合征的臨床研究　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：本論文包括文獻(xiàn)綜述和臨床研究兩個部分。文獻(xiàn)綜述共2篇,第一篇為西醫(yī)綜述,回顧了西醫(yī)對手足綜合征的認(rèn)識及防治研究進(jìn)展,包括引起手足綜合征的常見化療藥物、卡培他濱的臨床應(yīng)用、手足綜合征的發(fā)生機(jī)制、臨床表現(xiàn)、分級診斷標(biāo)準(zhǔn)以及西藥防治手足綜合征的現(xiàn)狀。手足綜合征是卡培他濱化療過程中最常見的不良反應(yīng)之一,主要表現(xiàn)為掌跖部感覺障礙及紅斑,嚴(yán)重者可見潰瘍、脫屑及劇烈疼痛。手足綜合征降低了患者的生活質(zhì)量,同時影響了卡培他濱化療過程的順利進(jìn)行,常常導(dǎo)致藥物減量或中斷治療,嚴(yán)重影響了化療的預(yù)期臨床療效�，F(xiàn)代醫(yī)學(xué)對其發(fā)病機(jī)制做了有意義的探索,但仍未達(dá)成共識。在治療方面,提倡健康宣教、局部護(hù)理等一般治療及維生素B6、環(huán)氧化酶抑制劑、DPD酶抑制劑等藥物治療,但防治療效并不理想,臨床有效率并不滿意,有待于進(jìn)一步深入探索與研究。第二篇為中醫(yī)綜述,回顧了中醫(yī)對手足綜合征的認(rèn)識,以及近年來中醫(yī)藥防治手足綜合征的研究進(jìn)展,對中醫(yī)藥不同臨床劑型的應(yīng)用做了初步總結(jié),包括外用劑、內(nèi)服劑、注射劑、灸法等。著重總結(jié)了外用制劑的臨床應(yīng)用,如外洗劑、熏洗劑、油劑、散劑、膏劑等。中醫(yī)藥各類制劑以療效佳、副作用小,廣泛地應(yīng)用于手足綜合征的防治中。大量學(xué)者基于臨床觀察證實,中醫(yī)藥對手足綜合征具有獨(dú)特的防治優(yōu)勢。但各醫(yī)家對本病的認(rèn)識觀點(diǎn)不一,治療思路亦不盡相同,仍有待我們進(jìn)一步發(fā)掘與探索。并從幾個方面論述了本項臨床觀察�；谀[瘤患者的特殊體質(zhì)及卡培他濱化療引起的不良反應(yīng),得出手足綜合征可能的發(fā)病機(jī)理為"瘀、熱、毒搏結(jié)難解,客于手足部絡(luò)脈,損傷脈絡(luò)筋經(jīng)",并辨證為"瘀熱入絡(luò)證"。確立"化瘀、清熱、解毒"為治療大法,選擇清熱解毒的代表方劑仙方活命飲為基礎(chǔ)方,甄選藥物加減化裁,制成外用湯劑進(jìn)行臨床干預(yù)性研究,旨在研究其對HFS的治療意義,為HFS的防治提供新的可借鑒的方法和途徑。臨床研究部分,觀察并總結(jié)了加味仙方活命飲外用對卡培他濱所致手足綜合征的臨床療效。[研究目的]觀察加味仙方活命飲外用治療手足綜合征的臨床療效及安全性。[研究方法]本課題按照納入標(biāo)準(zhǔn),納入30例卡培他濱化療的腫瘤患者,采用前后自身對照的方法,予加味仙方活命飲煎湯溫浴手足,每次30min,每天2次,早晚各一次。溫浴后即予藥包外敷患處,每次30min,每天2次。7天為1個療程,共2個療程。治療前后分別進(jìn)行手足綜合征分級評價、臨床癥狀評分、疼痛程度評分及一般狀態(tài)評分,并評估療效及安全性。[研究結(jié)果]30例患者中,有18例患者HFS臨床分級下降,8例患者維持穩(wěn)定狀態(tài);有26例患者臨床癥狀不同程度減輕,總有效率為86.67%(26/30);疼痛總緩解率為90%(27/30),完全緩解率為36.67%(11/30);一般狀態(tài)(精神狀態(tài)、情志、食欲及睡眠)總改善率為80%(24/30)。且治療前后未出現(xiàn)皮膚過敏、皮疹等不良反應(yīng)。各項數(shù)據(jù)比較,P值均0.05,差異具有統(tǒng)計學(xué)意義。[研究結(jié)論]加味仙方活命飲外用對卡培他濱化療所致的手足綜合征具有一定療效,且安全性尚可,值得進(jìn)一步臨床推廣研究。
[Abstract]:This paper consists of two parts: literature review and clinical research. The literature review consists of 2 parts, the first part is the review, review the research progress of Western medicine recognition and prevention of hand foot syndrome, including common chemotherapy drugs and handfoot syndrome of capecitabine and clinical application of hand foot syndrome pathogenesis, clinical manifestations, diagnostic criteria and classification status of Western medicine comprehensive prevention of hand foot sign. Hand foot syndrome is one of the most common adverse reactions of capecitabine chemotherapy process, mainly for sensory disturbance and palmoplantar erythema, severe visible ulcer, desquamation and severe pain. Hand foot syndrome reduces the quality of life of patients, and affects the successful progress of capecitabine chemotherapy, which often leads to drug loss or interruption, which seriously affects the expected clinical efficacy of chemotherapy. Modern medicine has made meaningful exploration to its pathogenesis, but no consensus has been reached. In terms of treatment, we advocate health education, local care and other general treatment and vitamin B6, cyclooxygenase inhibitors, DPD enzyme inhibitors and other drugs, but the curative effect is not ideal, the clinical efficiency is not satisfied, and needs further exploration and research. The second article review of Chinese medicine, reviewed the understanding of Chinese medicine on hand foot syndrome, and in recent years the study of hand foot syndrome of Chinese medicine in the prevention and application of traditional Chinese medicine in different clinical forms made a preliminary summary, including topical agent, oral agent, injection and moxibustion etc.. The clinical application of external preparation, such as external lotion, fumigant, oil, powder, plaster and so on, was summarized. The traditional Chinese medicine is widely used in the prevention and treatment of hand foot syndrome with good curative effect and small side effect. A large number of scholars have proved that traditional Chinese medicine has a unique preventive advantage on hand foot syndrome based on clinical observation. However, doctors have different views on the disease, and the treatment ideas are not the same. It still needs to be further explored and explored. The clinical observation is discussed from several aspects. Based on the special physical constitution and adverse reactions caused by capecitabine chemotherapy, the possible pathogenesis of hand foot syndrome is "stasis, heat, toxin and collaterals", "the meridian of the hand and foot is collateral, and the meridian channel is damaged", and it is identified as "stasis heat entering the collateral syndrome". The establishment of "removing blood stasis, clearing heat, detoxification treatment method, choose the representative prescription of Xian Fang Huo Ming Yin Qingrejiedu based drug selection, chmical process, research into external Decoction clinical intervention, in order to study on the treatment of HFS, provides the method and the way new for the prevention and treatment of HFS. In the part of clinical study, the clinical effect of Jiawei Xianfang activating drink on hand and foot syndrome caused by capecitabine was observed and summarized. [Objective] to observe the clinical efficacy and safety of Jiawei Xian Fang Decoction for external use in the treatment of hand foot syndrome. [Methods] according to the inclusion criteria, 30 cases of tumor patients in capecitabine chemotherapy. Methods before and after treatment, treated with the modified by xianfanghuomingyin frying bath we brothers, 30min each time, 2 times a day, sooner or later each time. After a warm bath, it is given to the affected area with a package of 30min, 2 times a day. 7 days for 1 courses, a total of 2 courses. The grading evaluation of hand foot syndrome, clinical symptom score, pain degree score and general state score were carried out before and after treatment, and the efficacy and safety were evaluated. [results]30 patients, clinical classification of 18 cases of patients with HFS decreased, 8 patients remain stable; there are 26 cases of patients with clinical symptoms were alleviated, the total effective rate was 86.67% (26/30); pain the total remission rate was 90% (27/30), the complete remission rate was 36.67% (11/30); the general state (mental state, emotion, appetite and sleep) the total improvement rate was 80% (24/30). There were no adverse reactions such as skin allergy and skin rash before and after treatment. The P values were 0.05, and the difference was statistically significant. [Conclusion] external application of jiaxianxianhuo Yin has certain effect on hand foot syndrome caused by capecitabine chemotherapy, and its safety is acceptable. It is worthy of further clinical research.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R730.5

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