本文關(guān)鍵詞：晚期非小細胞肺癌TP方案化療前后中醫(yī)證候特征臨床研究　出處：《南京中醫(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】：目的:本課題采用前瞻性的研究方法,觀察晚期非小細胞肺癌患者TP方案化療前后中醫(yī)證候特征,探討肺癌發(fā)病機制,TP方案化療前后中醫(yī)證候的演變規(guī)律,以及中醫(yī)藥配合化療的最佳切入點,為晚期非小細胞肺癌的臨床診療提供重要理論依據(jù)。方法:選取2016年4月至2016年12月,在江蘇省中醫(yī)院、江蘇省腫瘤醫(yī)院病房及門診確診為晚期非小細胞肺癌患者50例。通過調(diào)查問卷方式記錄TP方案化療前d7、化療后d8、化療后dl5三個時間點的癥狀、體征、舌苔、脈象等,并根據(jù)相關(guān)中醫(yī)診斷標準進行辨證分型。用SPSS20.0建立數(shù)據(jù)庫,分析化療前后中醫(yī)證候的變化規(guī)律,計數(shù)資料選用x2檢驗,計量資料選用方差分析,P0.05為有統(tǒng)計學(xué)差異。結(jié)果:(1)男女人群發(fā)病率未見明顯統(tǒng)計學(xué)差異;61-70歲為高發(fā)人群,50歲較50歲人群發(fā)病率高。(2)IIIB與IV期非小細胞肺癌患者在年齡、性別、中醫(yī)證型構(gòu)成未見明顯差異。(3)化療前d7咳嗽、痰多質(zhì)粘、痰中帶血、倦怠乏力、胸悶氣喘等癥狀多見,淡紅舌、白膩苔最多,分別占50%、48%,其次是紅舌、薄白苔、少苔分別占28%、22%、20%。脈象以滑脈38%居多,細弱脈24%繼之。證型分布以痰濕證、氣虛證、陰虛內(nèi)熱證為多,分別占38%、22%、20%。(4)化療后d8咳嗽咳痰、痰中帶血、胸痛、胸悶氣喘等肺系相關(guān)癥狀緩解,納差、惡心嘔吐、脫發(fā)、關(guān)節(jié)酸痛、手足麻木、目澀、便干等癥狀明顯增加。淡紅舌、白膩苔減少至26%,20%,少苔、紅舌和齒痕舌分別增至42%、38%、24%,黃膩苔和紫暗舌也稍有增加。滑脈顯著減少至12%,細數(shù)脈和細弱脈呈上升趨勢,達30%及40%。相對應(yīng)的痰濕證、氣虛證明顯減少至20%、10%,氣陰兩虛證、陰虛內(nèi)熱證較前增長,占32%和26%。(5)化療后dl5同樣表現(xiàn)為痰濕證、氣虛證減少,陰虛內(nèi)熱證、氣陰兩虛證較前增多,瘀阻肺絡(luò)證達10%。但是化療后dl5與化療后d8天相比,舌象、脈象、證型變化未見統(tǒng)計學(xué)差異,而在癥狀上有差異,主要表現(xiàn)為惡心嘔吐、納差等消化道癥狀緩解顯著。結(jié)論:晚期非小細胞肺癌患者TP方案化療前后中醫(yī)證候演變有一定的規(guī)律可循�；熐耙蕴禎褡C為主,氣虛證及陰虛內(nèi)熱證也占有一定的比例,化療后痰濕證、氣虛證明顯減少,氣陰兩虛證、陰虛內(nèi)熱證較前增加,表明TP方案即紫杉醇加順鉑為熱毒之品,耗氣傷陰,損傷肝腎,提示采取TP方案化療的患者可提前予以益氣、養(yǎng)陰、清熱,調(diào)補肝腎,并輔以活血化瘀。
[Abstract]:Objective: this topic using prospective research method, observation of advanced non small cell lung cancer patients before and after TP regimen chemotherapy the characteristics of TCM syndromes and investigate the pathogenesis of lung cancer, the evolution regularity of TCM syndromes before and after TP chemotherapy, and the traditional Chinese medicine with the best starting point for chemotherapy, provides an important theoretical basis for clinical diagnosis and treatment for advanced non-small cell lung cancer. Methods: from April 2016 to December 2016, 50 patients with advanced non-small cell lung cancer were diagnosed in Jiangsu Province Traditional Chinese Medicine Hospital, Jiangsu tumor hospital ward and outpatient clinic. The symptoms, signs, tongue fur and pulse condition of three time points before TP chemotherapy, D7, D8 after chemotherapy and DL5 after chemotherapy were recorded by questionnaires. Database was established by SPSS20.0, and the change rule of TCM syndromes before and after chemotherapy was analyzed. X2 test was used to count data, and variance analysis was used to measure data. P0.05 was statistically significant. Results: (1) there was no significant difference in the incidence of the male and female population; 61-70 years old was a high incidence population, and the incidence of the 50 year old population was higher at the age of 50. (2) there was no significant difference in age, sex and TCM syndrome type between IIIB and IV patients with non-small cell lung cancer. (3) before chemotherapy D7 cough, phlegm, sputum with blood viscosity, fatigue, chest tightness, shortness of breath and other symptoms more common, pale red tongue, white and greasy fur, accounted for 50%, 48%, followed by Bo Baitai, red tongue, little coating accounted for 28%, 22%, 20%. 38% pulse to pulse are fine and quick after 24%. The distribution of syndrome type was more than that of phlegm damp syndrome, Qi deficiency syndrome and yin deficiency internal heat syndrome, which accounted for 38%, 22% and 20% respectively. (4) after chemotherapy of d8 cough and expectoration, bloody sputum, chest pain, chest tightness, asthma and other lung related symptoms, anorexia, nausea and vomiting, hair loss, joint pain, numbness, dry eyes, dry stool and other symptoms significantly increased. Pale red tongue, white and greasy fur is reduced to 26%, 20%, less moss, red tongue and tooth marked tongue were increased to 42%, 38%, 24%, and Huang Nitai, dark purple tongue is also slightly increased. Pulse was reduced to 12%, and the fine and quick pulse count increased up to 30% and 40%. The corresponding phlegm dampness syndrome and Qi deficiency proved to be reduced to 20%, 10%, Qi Yin two deficiency syndrome and yin deficiency internal heat syndrome, accounting for 32% and 26%. (5) after chemotherapy, DL5 also showed that the syndrome of phlegm dampness and Qi deficiency decreased, the syndrome of yin deficiency and internal heat, deficiency of Qi and Yin were increased, and the syndrome of stagnation of lung and collaterals was 10%. But DL5 after chemotherapy and chemotherapy after D8 days compared, tongue and pulse, different syndromes of no significant difference, but there are differences in symptoms, mainly for nausea and vomiting, anorexia and other gastrointestinal symptoms significantly. Conclusion: there is a certain regularity in the evolution of TCM syndrome before and after TP chemotherapy in patients with advanced non-small cell lung cancer (non-small cell lung cancer). Before chemotherapy with phlegm, Qi deficiency and yin deficiency syndrome also occupy a certain proportion, after chemotherapy, phlegm, Qi deficiency obviously reduced, two Qi and yin deficiency syndrome, yin deficiency syndrome was increased than before, which shows that the TP of paclitaxel plus cisplatin for heat, Yin consumption, liver kidney injury take the TP chemotherapy, patients can advance to Qi, nourishing Yin, clearing heat, nourishing the liver and the kidney, and supplemented with blood stasis.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

【參考文獻】

相關(guān)期刊論文 前10條

1 蔣健鴻;徐力;;徐力教授“三段六辨”抗癌模式治療肺癌經(jīng)驗[J];中醫(yī)藥導(dǎo)報;2016年18期

2 張仁鋒;張巖;溫豐標;吳愷;趙松;;6,058例肺癌患者病理類型和臨床流行病學(xué)特征的分析[J];中國肺癌雜志;2016年03期

3 李向蓮;唐雪莉;李幼平;李萃萃;張小紅;;EGFR-TKI與化療比較一線治療晚期非小細胞肺癌有效性和安全性的系統(tǒng)評價[J];中國循證醫(yī)學(xué)雜志;2016年02期

4 巫云立;黃菁;王巍煒;張勇;;順鉑聯(lián)合紫杉醇脂質(zhì)體治療晚期肺鱗癌的臨床觀察[J];中國醫(yī)學(xué)創(chuàng)新;2016年04期

5 王珊珊;郭茗;朱W，

本文編號：1346594