本文選題：肺癌 + 老年��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的:以在廣安門醫(yī)院腫瘤科住院、生存時(shí)間較長的80歲及以上的高齡老年肺癌患者為研究對象,觀察患者的生存期,探索單純辨證湯藥治療與中西醫(yī)結(jié)合治療療效的差異以及影響高齡老年肺癌的預(yù)后因素,為治療策略的制定提供初步依據(jù)。研究方法:本研究采用臨床回顧性調(diào)查方法,對2002年01月01日至2015年12月31日期間入院初治的、口服中藥湯藥的、生存期在6個(gè)月及以上的80歲及以上的中晚期肺癌患者病例進(jìn)行研究,分為單純中醫(yī)組和中西醫(yī)結(jié)合組,研究的終點(diǎn)指標(biāo)為總生存期和1、3、5年生存率。研究結(jié)果:1、基本特征:本研究入組68例患者,平均年齡為82.19±2.645歲。分為單純中醫(yī)組47例,占69.1%;中西醫(yī)結(jié)合組21例,占30.9%。其中臨床Ⅲ期23例,占33.8%;臨床Ⅳ期45例,占66.1%。PS評分1分40例,占58.8%;PS評分2分28例,占41.2%。病理類型明確者共37例,占54.4%,其中鱗癌11例,占16.2%;腺癌26例,占23.5%;病理不詳者31例,占45.6%。辨證分型:包括脾虛痰濕證、氣陰兩虛證、痰熱互結(jié)證、痰瘀互阻證、肺脾氣虛證、肺腎兩虛證、氣虛血瘀證等組合而成。2、生存分析:整個(gè)研究人群的中位總生存期為:22個(gè)月。1、3、5年累積生存率分別為66.2%、44.1%、17.6%。單純中醫(yī)組與中西醫(yī)結(jié)合組的1、3、5年累積生存率組間無統(tǒng)計(jì)學(xué)差異(P=0.098)。其中37例病理明確的患者中位生存期為19.0個(gè)月,分為單純中醫(yī)組23例(中位生存期為18.0個(gè)月)、中西醫(yī)結(jié)合組14例(中位生存期為23.0個(gè)月),組間差異無統(tǒng)計(jì)學(xué)差異(P0.05)。生存期的單因素分析:按PS評分分組比較,差異有統(tǒng)計(jì)學(xué)意義(P=0.013),評分為2分的患者中位生存期為8.0個(gè)月,但無法得出PS評分為1分的患者中位生存期,考慮與截尾數(shù)據(jù)較高(60.0%)有關(guān)。31例病理不詳?shù)幕颊咧形簧嫫跒?4.0個(gè)月,其中單純中醫(yī)組24例、中西醫(yī)結(jié)合組7例。分層分析37例病理明確的患者單純中醫(yī)治療與中西醫(yī)結(jié)合治療的中位生存期:PS評分2分(6.0個(gè)月vs 17.0個(gè)月)、臨床Ⅲ期(28.0個(gè)月vs 17.0個(gè)月)、臨床Ⅳ期(16.0個(gè)月vs 23.0個(gè)月)、單一證型(18.0個(gè)月vs 17.0個(gè)月)、合并癥輕度(28.0個(gè)月vs 19.0個(gè)月)、合并癥中度(16.0個(gè)月vs 23.0個(gè)月)、吸煙(16.0個(gè)月vs 17.0個(gè)月)、鱗癌(10.0個(gè)月vs 17.0個(gè)月)分層,兩組OS之間均未見統(tǒng)計(jì)學(xué)差異。中西醫(yī)結(jié)合組不良反應(yīng)發(fā)生率為60.0%,高于單純中醫(yī)藥組不良反應(yīng)發(fā)生率的8.3%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、Cox回歸分析:方程中的變量為PS評分和中醫(yī)證型,回歸方程模型有統(tǒng)計(jì)學(xué)意義(P0.05)。4、中醫(yī)治療特點(diǎn)分析:37例病理明確的患者入院時(shí)所見最常見的中醫(yī)證型為痰瘀互阻證,而后為氣陰兩虛證、脾虛痰濕證、肺脾氣虛證、痰熱互結(jié)證、肺腎兩虛證、氣虛血瘀證。31例病理不詳?shù)幕颊呷朐簳r(shí)所見最常見的中醫(yī)證型為氣陰兩虛證,而后為痰瘀互阻證、脾虛痰濕證、肺脾氣虛證、痰熱互結(jié)證、肺腎兩虛證、氣虛血瘀證。無論病理是否明確,患者入院所用中藥中補(bǔ)氣藥、化痰止咳平喘藥、理氣藥、補(bǔ)陰藥的使用頻次均為最高。對病理明確的患者治療以補(bǔ)氣扶正、理氣化痰為主,輔以清熱解毒、養(yǎng)陰、消食、活血、止血等法;對病理不詳?shù)幕颊咧委熞匝a(bǔ)氣養(yǎng)陰、理氣化痰為主,輔以清熱解毒、利水滲濕、消食、活血、收澀等法。結(jié)論:1、治療80歲及以上的高齡老年中晚期肺癌患者,單純中醫(yī)治療與中西醫(yī)結(jié)合治療對生存期的療效無明顯差異,單純中醫(yī)治療的安全性更好。2、PS評分是80歲及以上中晚期高齡老年肺癌患者預(yù)后的可能影響因素。PS評分、單一中醫(yī)證型是影響患者死亡的獨(dú)立危險(xiǎn)因素。3、高齡老年中晚期肺癌患者,由于體質(zhì)偏弱,難以耐受手術(shù)及放化療等治療手段,多愿接受中醫(yī)藥(包括中西醫(yī)結(jié)合)治療。其中醫(yī)辨證屬本虛標(biāo)實(shí)、虛實(shí)夾雜、以虛為主;中醫(yī)治療以扶正(益氣、養(yǎng)陰)為主,輔以祛邪(清熱解毒、活血化瘀、化痰祛濕)之法。
[Abstract]:Objective: To study the survival time of the elderly patients with lung cancer in the hospital of the oncology department of the hospital of Guanganmen for a longer survival time of 80 years and above, to explore the difference in the curative effect of the treatment of simple Decoction and the combination of Chinese and Western medicine as well as the prognostic factors of the elderly patients with lung cancer, and to provide the treatment strategy. Preliminary basis. Research methods: This study used a clinical retrospective survey method to study the cases of middle and late lung cancer patients who were taken orally with Chinese herbal medicine in the first period of 01 months from 01 to December 31, 2015 2002 to the middle and advanced lung cancer patients with the survival period of 6 months or more. The study was divided into the end of the study and the end of the study. The index was the total life and 1,3,5 year survival rate. The results were as follows: 1, the basic features: 68 patients in the study group, with the average age of 82.19 + 2.645 years, were divided into only 47 cases of traditional Chinese medicine, 69.1%, 21 cases in the combination group of Chinese and Western medicine, which accounted for 23 of the clinical stage III, accounting for 33.8%, and 45 cases in the clinical stage IV, accounting for 1 scores of 58.8% in the 66.1%.PS score, and PS score 2 divide. A total of 37 cases, accounting for 54.4% of 41.2%. pathological types, 11 cases of squamous cell carcinoma, 16.2%, 26 cases of adenocarcinoma, 23.5%, 31 cases of unknown pathology, accounting for 45.6%. syndrome differentiation, including spleen deficiency phlegm damp syndrome, Qi Yin two deficiency syndrome, phlegm heat mutual syndrome, phlegm stasis syndrome, lung kidney two deficiency syndrome, Qi deficiency syndrome, Qi deficiency and blood stasis syndrome and so on into.2, survival analysis: the whole survival analysis: the whole survival analysis: the whole survival analysis: the whole survival analysis: the whole analysis: the whole survival analysis: the whole analysis: the whole analysis: the whole Analysis: the whole analysis: the whole analysis: the whole analysis: the whole The median total survival time of the study group was: the cumulative survival rate of 22 months.1,3,5 years was 66.2%, 44.1%. There was no statistical difference between the group of traditional Chinese medicine and the combination of traditional Chinese and Western medicine in the cumulative survival rate (P=0.098). Among them, the median survival time of 37 patients with clear pathology was 19 months, which was divided into 23 cases in the simple Chinese medicine group (median survival time was 1). 8 months), 14 cases (median survival period was 23 months) in the group of Chinese and Western Medicine (median survival period 23 months). There was no statistical difference between the groups (P0.05). The single factor analysis of the survival period: the difference was statistically significant (P=0.013) according to the PS score, and the median survival time of the patients with a score of 2 was 8 months, but the median survival time of the patients with a PS score was 1. The median survival time of patients with.31 cases (60%) was 24 months, including 24 cases in traditional Chinese medicine group and 7 cases of integrated traditional Chinese and Western medicine. The median survival period of 37 patients with pathological diagnosis was PS score 2 (6 months vs 17 months) and 28 clinical stage (28). Month vs 17 months), clinical IV (16 months vs 23 months), single syndrome (18 months vs 17 months), mild complication (28 months vs 19 months), amalgamative moderate (16 months vs 23 months), smoking (16 months vs 17 months), squamous cell carcinoma (10 month vs 17 months) stratification, there are no statistical differences between the OS and the traditional Chinese and Western medicine. The incidence of adverse reactions in the combined group was 60%, which was higher than 8.3% of the incidence of adverse reactions in the simple Chinese medicine group. The difference was statistically significant (P0.05).3, Cox regression analysis: the variables in the equation were PS and TCM syndrome, and the regression equation model had statistical significance (P0.05).4, and the characteristics of medical treatment in 37 cases were most seen in the hospital. The common TCM syndrome type is phlegm stasis syndrome, then Qi Yin two deficiency syndrome, spleen deficiency phlegm dampness syndrome, lung spleen qi deficiency syndrome, phlegm heat syndrome, lung kidney two deficiency syndrome, Qi deficiency and blood stasis syndrome.31 cases of the most common TCM syndrome type are Qi Yin two deficiency syndrome, and then phlegm stasis syndrome, spleen deficiency phlegm damp syndrome, lung spleen qi deficiency syndrome and phlegm heat interknot. Syndrome, two deficiency of lung and kidney, Qi deficiency and blood stasis syndrome. No matter whether the pathology is clear, the use frequency of tonifying medicine in Chinese medicine, expectorant antitussive antiasthmatic medicine, physical Qi medicine and nourishing Yin medicine are the highest. The patients were treated for nourishing qi and nourishing Yin, nourishing qi and resolving phlegm, supplementing with the methods of clearing heat and detoxifying, removing water, eliminating food, activating blood and receiving astringent, etc. conclusion: 1, the treatment of middle and advanced lung cancer patients with 80 years old and above has no significant difference in the curative effect of the survival period with the combination of traditional Chinese medicine and traditional Chinese medicine, and the safety of the simple Chinese medicine treatment is better.2, PS The score is a possible influencing factor of the prognosis of lung cancer patients aged 80 and above in the middle and advanced age. The single TCM syndrome is an independent risk factor affecting the death of the patients.3. The elderly and advanced lung cancer patients are difficult to tolerate surgery and radiotherapy and chemotherapy because of the weak constitution, and they are willing to accept Chinese medicine (including the combination of Chinese and Western Medicine). Treatment. Among them, the TCM syndrome differentiation belongs to the virtual standard, the deficiency and the real inclusion, and the deficiency mainly; the traditional Chinese medicine is based on Fuzheng (Yiqi, Yin nourishing), supplemented by the method of removing evil spirits (clearing heat and detoxifying, activating blood and removing stasis, eliminating phlegm and dispelling dampness).
【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(hào)】：R273

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本文編號(hào)：1998451