本文關(guān)鍵詞：曹利平教授學(xué)術(shù)思想及健脾清肺湯改善晚期非小細(xì)胞肺癌生活質(zhì)量的臨床研究　出處：《中國(guó)中醫(yī)科學(xué)院》2017年博士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 曹利平 老中醫(yī)經(jīng)驗(yàn) 非小細(xì)胞肺癌 脾虛肺熱證 健脾清肺湯

【摘要】：目的本研究旨在根據(jù)對(duì)曹利平教授臨床經(jīng)驗(yàn)的系統(tǒng)梳理,歸納總結(jié)遣方用藥特點(diǎn),挖掘整理名老中醫(yī)的學(xué)術(shù)經(jīng)驗(yàn),凝煉曹利平教授的學(xué)術(shù)思想;并通過(guò)臨床研究驗(yàn)證“健脾清肺湯”改善晚期非小細(xì)胞肺癌患者的生活質(zhì)量,評(píng)價(jià)其對(duì)中醫(yī)證候、生存時(shí)間和生存質(zhì)量的影響,建立基于曹利平教授學(xué)術(shù)思想治療非小細(xì)胞肺癌的中醫(yī)藥診療方案。方法1學(xué)術(shù)經(jīng)驗(yàn)研究通過(guò)曹利平教授從醫(yī)及跟師經(jīng)歷、臨證經(jīng)驗(yàn),臨床跟師門(mén)診、專(zhuān)題討論、疑難病會(huì)診,并查閱曹利平教授的有關(guān)著作、中醫(yī)醫(yī)案及3年來(lái)的跟師筆記、肺癌醫(yī)案整理等形式,歸納總結(jié)曹利平教授治療腫瘤尤其是非小細(xì)胞肺癌、肺系疾病及內(nèi)科雜癥的臨床經(jīng)驗(yàn),梳理曹利平教授的學(xué)術(shù)脈絡(luò)。2臨床研究采用平行、對(duì)照的方法,于2012年10月-2015年10月在陜西省中醫(yī)醫(yī)院及陜西省腫瘤醫(yī)院兩家醫(yī)院,觀察Ⅲ期、Ⅳ期非小細(xì)胞肺癌脾虛肺熱證患者69例,其中治療組35例、對(duì)照組34例。治療組給予健脾清肺湯聯(lián)合西醫(yī)基礎(chǔ)治療方案,對(duì)照組給予西醫(yī)基礎(chǔ)治療方案,治療12周為一療程。采用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)分析,對(duì)兩組患者中醫(yī)證候、生存質(zhì)量、體力狀況及總生存期等指標(biāo)進(jìn)行客觀評(píng)價(jià)。結(jié)果1學(xué)術(shù)經(jīng)驗(yàn)研究本文首先總結(jié)歸納出曹利平教授臨證經(jīng)驗(yàn),并提煉升華形成曹利平教授的學(xué)術(shù)思想:即治療肺系疾病體現(xiàn)在“肺以清為本”,治療內(nèi)科雜癥重視從肺論治,擅長(zhǎng)運(yùn)用溫膽湯治療頑疾。其次總結(jié)出曹利平教授治療非小細(xì)胞肺癌的特點(diǎn):本虛標(biāo)實(shí)是肺癌發(fā)生發(fā)展的主要病因病機(jī),邪熱蘊(yùn)肺是肺癌之標(biāo)、脾氣虧虛是肺癌之本,強(qiáng)調(diào)肺脾同調(diào)是辨治肺癌的主要措施,健脾清肺是治療非小細(xì)胞肺癌的一個(gè)重要治則。曹利平教授認(rèn)為脾氣虧虛,健運(yùn)失司,痰濁內(nèi)生,上犯于肺,痰濕阻絡(luò),日久氣血瘀滯,瘀久化熱,痰、濕、瘀、熱交阻而成肺積。脾虛肺熱證型是臨床常見(jiàn)證型之一,其臨癥可見(jiàn)咳嗽、咯痰,痰白或?yàn)辄S痰或痰中帶血,伴乏力、氣短,活動(dòng)后加重,舌質(zhì)淡紅、白膩或黃膩苔,脈沉細(xì)或弦滑。針對(duì)脾虛肺熱證,以健脾清肺為治則,予以健脾氣、清肺熱,自擬健脾清肺湯進(jìn)行治療。健脾即是固本,治療肺癌肺脾同治這是培土生金法在臨床的具體體現(xiàn)和應(yīng)用。為治療非小細(xì)胞肺癌,曹教授集多年臨證經(jīng)驗(yàn)形成自擬健脾清肺湯,其臨床效果明顯。自擬健脾清肺湯組成:枳殼、桔梗、陳皮、法半夏、茯傮、黃芩、桑白皮、浙貝母、夏枯草、忍冬藤、炒白術(shù)、太子參、炒麥芽、防風(fēng)、蘇葉、薏苡仁、烏賊骨、甘草。健脾清肺法是本文總結(jié)出的曹利平教授治療非小細(xì)胞肺癌的重要法則,適用于脾虛肺熱證的病人,貫穿于疾病治療的始終,按此法組方的健脾清肺湯可廣泛用于術(shù)后、放化療后及晚期非小細(xì)胞肺癌患者,可以長(zhǎng)期使用。在健脾清肺湯的臨床應(yīng)用中應(yīng)注重辨期治療,根據(jù)病人不同臨床表現(xiàn)酌情調(diào)整用藥。若患者處于西醫(yī)手術(shù)、放、化療等治療期,相應(yīng)調(diào)整健脾清肺湯方中藥物的劑量,加大益氣補(bǔ)氣的中藥用量,以加強(qiáng)固本作用。同時(shí)在調(diào)整劑量的基礎(chǔ)上,針對(duì)化療患者惡心嘔吐的情況,可酌加竹茹、生姜、大棗以和胃止嘔;對(duì)白細(xì)胞低下患者常加黃芪、女貞子等補(bǔ)氣滋補(bǔ)腎陰;對(duì)放療期間及放療后口干、咽干的患者加石斛、蘆根、百合等滋陰潤(rùn)肺之品以減輕放射熱源引起的燥熱傷津癥狀;若患者處于術(shù)后、放化療后穩(wěn)定期及早期,則應(yīng)在健脾清肺湯中加大清肺、化痰、散結(jié)的中藥用量以加強(qiáng)祛邪抗瘤作用;對(duì)于晚期及衰竭的患者,在加大益氣培本的中藥用量同時(shí)需減少清肺、化痰、散結(jié)的中藥用量,即加大扶正力度又減輕驅(qū)邪的力量,從而更能適應(yīng)患者病情的需要。2臨床研究結(jié)果中醫(yī)證侯方面:中醫(yī)證候積分:治療組中醫(yī)證候積分治療前后經(jīng)t檢驗(yàn),t=11.086,P=0.000;兩組療后經(jīng)檢驗(yàn),t=-2.628,P=0.011,比較均有顯著性差異(P0.05)。其中,治療組咳嗽癥狀積分治療前后經(jīng)t檢驗(yàn),t=11.22,P=0.004;兩組療后經(jīng)檢驗(yàn),t=-2.66,P=0.01;比較均有顯著性差異(P0.05)。治療組咳痰積分治療前后經(jīng)t檢驗(yàn),t=17.92,P=0.017;兩組療后經(jīng)檢驗(yàn),t=-3.01,P=0.004,比較均有顯著性差異(P0.05)。治療組氣短癥狀治療前后經(jīng)t檢驗(yàn),t=7.85,P=0.001,比較有顯著性差異(P0.05);兩組療后經(jīng)檢驗(yàn),t=-1.93,P=0.057,比較無(wú)顯著性差異(P0.05)。治療組乏力癥狀積分治療前后經(jīng)t檢驗(yàn),t=9.22,P=0.026;兩組療后經(jīng)檢驗(yàn),t=-3.96,P=0.00,比較均有顯著性差異(P0.05)。中醫(yī)證候療效:治療組35例中顯效7例,占20.00%;有效23例,占65.71%;無(wú)效5例,占14.29%;對(duì)照組34例中顯效2例,占5.9%;有效19例,占55.88%;無(wú)效13例,占38.24%。兩組經(jīng)卡方檢驗(yàn),x2=6.524,P=0.038,P0.05,比較有顯著性差異。功能評(píng)價(jià)方面:治療組肺癌生活質(zhì)量中日�；顒�(dòng)評(píng)分治療前后經(jīng)t檢驗(yàn),t=5.893,P=0.000;兩組療后經(jīng)t檢驗(yàn),t=-2.082,P=0.041,比較均有顯著性差異(P0.05)。治療組社會(huì)家庭評(píng)分治療前后經(jīng)t檢驗(yàn),t=-1.390,P=0.173,P0.05,比較無(wú)顯著性差異(P0.05)。兩組療后經(jīng)t檢驗(yàn),t=2.581,P=0.012,比較有顯著性差異(P0.05)。治療組情緒評(píng)分治療前后經(jīng)t檢驗(yàn),t=6.509,P=0.000;兩組療后經(jīng)t檢驗(yàn),t=2.245,P=0.0280.05,比較均有顯著性差異(P0.05)。治療組活動(dòng)能力評(píng)分治療前后經(jīng)t檢驗(yàn),t=-8.133,P=0.000,比較有顯著性差異(P0.05)。兩組療后評(píng)分經(jīng)t檢驗(yàn),t=1.865,P=0.0670.05,比較無(wú)顯著性差異(P0.05)。治療組附加關(guān)注評(píng)分治療前后經(jīng)t檢驗(yàn),t=5.822,P=0.000,比較有顯著性差異(P0.05)。兩組療后評(píng)分經(jīng)t檢驗(yàn),t=-0.515,P=0.609,比較無(wú)顯著性差異(P0.05)。體力狀況:卡氏評(píng)分療效治療組35例中卡氏評(píng)分提高27例,占77.14%;穩(wěn)定6例,占17.14%;下降2例,占5.72%;對(duì)照組34例中提高18例,占52.94%;穩(wěn)定7例,占20.59%;下降9例,占26.47%。兩組經(jīng)卡方檢驗(yàn),x2=6.257,P=0.042,比較有顯著性差異(P0.05)。體重療效方面:治療組35例中體重評(píng)分增加23例,占65.71%;穩(wěn)定7例,占20.00%;下降5例,占14.29%;對(duì)照組34例中增加19例,占55.88%;穩(wěn)定5例,占14.71%;下降10例,占29.41%。兩組經(jīng)卡方檢驗(yàn),x2=2.333,P=0.305,比較無(wú)顯著性差異(P0.05)。生存期方面:無(wú)進(jìn)展生存期:兩組患者無(wú)進(jìn)展生存期經(jīng)t檢驗(yàn),t=-4.892,P=0.033,比較有顯著性差異(P0.05)。研究過(guò)程中未發(fā)現(xiàn)明顯毒、副作用。結(jié)論1通過(guò)梳理曹利平教授臨證經(jīng)驗(yàn),歸納出曹利平教授治療肺系疾病、腫瘤及內(nèi)科雜病的學(xué)術(shù)理念�？偨Y(jié)出非小細(xì)胞肺癌的治則規(guī)律和組方用藥特點(diǎn),提出脾虛肺熱證是肺癌的重要而常見(jiàn)的證型,健脾清肺是治療非小細(xì)胞肺癌的一個(gè)重要治則,用自擬健脾清肺湯進(jìn)行治療。2健脾清肺湯改善非小細(xì)胞肺癌生活質(zhì)量的臨床研究結(jié)果顯示:治療組可明顯減輕患者的咳嗽、咳痰、氣短等癥狀,病人日�；顒�(dòng)、情緒、活動(dòng)能力等均得到改善,卡氏評(píng)分提高,生存時(shí)間延長(zhǎng),即治療組可明顯提高患者的生活質(zhì)量、延長(zhǎng)病人的生存時(shí)間。健脾清肺湯加西醫(yī)基礎(chǔ)治療在非小細(xì)胞肺癌的治療上優(yōu)于單純西醫(yī)基礎(chǔ)治療,有效安全。本研究提煉出曹利平教授的學(xué)術(shù)思想、治療非小細(xì)胞肺癌的特點(diǎn)及其指導(dǎo)下的“健脾清肺”的用藥規(guī)律,同時(shí)選用肺癌治療功能評(píng)價(jià)量表進(jìn)行該方療效的臨床實(shí)驗(yàn)評(píng)價(jià)分析,印證了健脾清肺法對(duì)肺癌患者具有的較優(yōu)療效。最終說(shuō)明來(lái)源于臨床多年的“健脾清肺湯”的組方切合臨床實(shí)際,符合非小細(xì)胞肺癌病機(jī)變化規(guī)律,是治療非小細(xì)胞肺癌的有效方劑,值得進(jìn)一步深入研究及臨床推廣。該研究為臨床治療非小細(xì)胞肺癌提供了新思路,為進(jìn)一步探討中藥維持治療晚期肺癌的治療方案、深層次挖掘名老中醫(yī)的學(xué)術(shù)內(nèi)涵提供參考依據(jù)和支撐。
[Abstract]:Objective the purpose of this study was to systematically according to Professor Cao Liping's clinical experience, summed up the characteristics of drug prescription, excavation of old Chinese medicine academic experience, refine the academic thoughts of Professor Cao Liping; and through clinical validation study "Jianpi Qingfei Decoction" to improve the quality of life of patients with non small cell lung cancer late evaluation of TCM syndrome effect, survival time and quality, the establishment of traditional Chinese medicine treatment of Professor Cao Liping's academic thought of non-small cell lung cancer. Methods based on the experience of 1 by Professor Cao Liping and doctor with teacher experience, clinical experience, clinical teachers with special clinic, discussion, consultation difficult disease, and access to books on Professor Cao Liping medical records of Chinese medicine, and 3 years with teacher notes, lung cancer medical record arrangement form, summary of Professor Cao Liping in treating tumors especially non-small cell lung cancer, lung diseases and Clinical experience of medical diseases, academic development.2 clinical research by Professor Cao Liping combing the parallel control method, in October 2012 -2015 year in October in Shaanxi Province Chinese medicine hospital and Tumor Hospital of Shaanxi province in two hospitals, observation of stage III, IV 69 cases of non small cell lung cancer patients with spleen deficiency and lung heat syndrome, including 35 cases of treatment group. 34 cases of the control group. The treatment group was given Qingfei Jianpi Decoction Combined with western medicine foundation treatment, the control group was given the basic treatment of Western medicine, treatment for 12 weeks. SPSS18.0 software was used for statistical analysis, the two groups of patients with TCM syndrome, quality of life, the objective evaluation index of physical situation and overall survival. Results 1 experience of this paper summarized professor Cao Liping's clinical experience, and refine the formation of Professor Cao Liping's academic thought is embodied in the treatment of lung disease lung to clear the "treatment 縐戞潅鐥囬噸瑙嗕粠鑲鴻娌，

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