本文選題：乳腺癌 + 中醫(yī)綜合療法��； 參考：《南京中醫(yī)藥大學》2017年博士論文

【摘要】：目的:本研究基于乳腺癌為全球婦女最多見的惡性腫瘤,新發(fā)和死亡率均排行第一位;乳腺癌病損部位特殊、發(fā)病原因與情緒有關及其生存期長,更決定乳腺癌術后生存質量的重要性。本研究收集60例女性乳腺癌術后病例,探討中醫(yī)綜合療法,包括中醫(yī)中藥聯(lián)合中醫(yī)心理治療對乳腺癌術后生活質量的影響,并將研究運用于臨床治療,不但有效地提高乳腺癌患者術后生活質量,包括減低臨床癥狀,提高心理健康、改善特定思想行為模式,增強社會適用能力。并為進一步以中醫(yī)綜合療法可減低乳腺癌復發(fā)轉移作為今后臨床、科研提供參考依據(jù)。方法:收集由2014-2016年在香港某癌癥關顧中心所采集60例乳腺癌患者,均經手術治療及病理確診為乳腺癌,分實驗組及對照組各30例。符合入選標準包括患者存在乳腺癌術后中醫(yī)肝郁痰凝證型癥狀,主癥包括神疲易倦、失眠多夢、抑郁/心煩易怒、便秘或便溏、納呆;次癥口苦或干、乳房脹痛、潮熱、多汗、月經不調、上肢水腫/麻痹、關節(jié)疼痛/腰痛等。C型人格行為模式問卷反映著有情感抑壓、自咎、偏執(zhí)人格傾向。漢米爾頓抑郁量表HAMD為輕度抑郁或以上。及乳腺癌患者生命尛量測定量表EORTC-QLQ30反映著軀體、角色、認知、情緒及社會功能的不足。本實驗包括12周中藥療程和4節(jié)中醫(yī)心理治療,觀察分析治療前后實驗組及對照組乳腺癌患者生命尛量測定量表EORTC-QLQ30、中醫(yī)臨床癥狀問卷、漢米爾頓抑郁量表(HAMD)、C型人格行為模式問卷的對比。統(tǒng)計學方法采用SPSS22.0統(tǒng)計學軟件包括建立數(shù)據(jù)庫,將數(shù)據(jù)統(tǒng)一錄入,本研究中資料符合正態(tài)分布,采用x±sd描述,P0.05為差異有統(tǒng)計學意義。結果:本研究經中醫(yī)綜合療法包括12周中藥療程和4節(jié)中醫(yī)心理治療后,結果如下:1.生命尛量測定量表EORTC-QLQ30,在整體總健康生活質量實驗組(3.95± 0.89),對照組為(3.10±1.08)。實驗組明顯提高有優(yōu)越性,(P0.05)有統(tǒng)計學意義。在功能子量表:認知功能、情緒功能、社會功能均明顯下降改善,反映著對比對照組,在綜合療法實驗下焦慮和抑郁情緒有改善。在臨床癥狀子量表:失眠、疲倦、氣促等癥狀均明顯下降改善,實驗組對比對照組(P0.05)有統(tǒng)計學意義。2.在中醫(yī)臨床癥狀定量表的統(tǒng)計結果,主癥神疲易倦、失眠多夢、抑郁/心煩易怒均效果明顯。脾胃功能便秘/便溏、納呆有效,(有顯著效果(P0.05)。次癥口苦或干有明顯改善。潮熱、乳房脹痛、關節(jié)疼痛/腰痛有效。在經化療或免疫治療后的臨床癥狀,如多汗、月經不調和上肢水腫/麻痹等效果不及其他癥狀明顯改進。3.在中醫(yī)臨床癥狀實驗組的30例,經12周中醫(yī)治療,其中17例效果明顯,9例有效,4例效果不明顯。5項主癥中3項有明顯效果,2項有效;7項次癥其中1項有明顯效果,3項有效,3項效果不明顯。4.HAMD漢米爾頓抑郁量表21項癥狀評分,實驗組在通過中醫(yī)綜合治療后,情緒方面,抑郁、遲滯、內咎;得分均下降有改善,實驗組對比對照組有顯著效果。焦慮層面:精神性焦慮及軀體焦慮得分均下降有改善。在軀體方面,全身癥狀、睡眠不深或困難對比對照組均有明顯改善。5.C型行為模式觀察得分顯示,實驗組在通過中醫(yī)綜合治療后,得分≤6,由原來10名患者增至16名,得分7-10由16名減少至11名,反映著原本習慣抑壓、自咎及偏執(zhí)人格傾向的C型行為模式的患者有明顯改善,患者趨向持開放態(tài)度,P0.05有差異統(tǒng)計意義。結論:本論文研究以采用中醫(yī)綜合療法包括中醫(yī)中藥和中醫(yī)心理治療,綜合4種不同問卷,進行縱橫多維度觀察乳腺癌術后生活質量,治療前后的臨床分級變化。乳腺癌術后生活質量在總體生活質量明顯優(yōu)越改善,反映著無論軀體、情緒、認知及社會功能等的優(yōu)化,合符世界衛(wèi)生組織(WHO)的生活質量定義,包括生理健康、正向認知和情緒的心理狀況和正常社會關系。實驗組經中醫(yī)綜合療法的12周中藥治療后,中醫(yī)臨床癥狀中的神疲易倦、失眠多夢、抑郁/心煩易怒、口苦或干效果明顯;便溏/便秘、納呆、潮熱、乳房脹痛、關節(jié)疼痛/腰痛有效;在化療后多項如月經不調、上肢水腫/麻痹效果不明顯。由于化療毒害殘留或需更長中醫(yī)治療時間、或采取針灸治療更有優(yōu)勢,有待探討。在月經不調的觀察,多為化療后沖任的破壞,需較長時間調理沖任。實驗組經中醫(yī)心理4節(jié)治療后,HAMD抑郁量表顯示抑郁情緒、遲滯、內咎,得分均下降,有明顯改善。焦慮層面,精神性焦慮及軀體焦慮得分亦均下降有改善,并在軀體方面,全身癥狀、睡眠不深或困難癥狀有明顯改善。實驗組經中醫(yī)心理4節(jié)心理疏導后,C型行為模式,即癌癥易感行為模式的患者人數(shù)有明顯減低。表示實驗組患者原本存在抑壓、自咎及偏執(zhí)人格傾向,有趨向持開放態(tài)度,學會增強自控能力及釋放焦慮、抑郁和憤怒情緒,調整和轉移痛苦情感,尤其經小組分享大家苦難經驗,學會公開表達自己的情緒和分享。在研究方面,以為期12周中藥及4節(jié)中醫(yī)心理治療,臨床癥狀有顯著成效,但并未全面化,或需采取較長治療時間及追蹤查訪,或配合其他中醫(yī)治療方法例如針灸深入探討療效。在心理情緒、思維性格模式范疇方面,經中醫(yī)心理治療后,成效立竿見影,某些輕癥可能有著短期反應和回饋,若配合較長期的心理鞏固治療,使患者不斷學習和加強自身素質,更能發(fā)揮其效益,最終達到提高及鞏固患者生活質量的目的。
[Abstract]:Objective: This study is based on breast cancer as the most common malignant tumor in the world. Both the new hair and the mortality are the first. The site of the breast cancer is special. The cause of the disease is related to the mood and the long survival time. It is more important for the survival quality of breast cancer. This study collected 60 cases of female breast cancer after operation, and discussed the combination of traditional Chinese medicine. Therapy, including traditional Chinese medicine and traditional Chinese medicine psychotherapy on the quality of life after breast cancer surgery, and applied to clinical treatment, not only effectively improve the quality of life of breast cancer patients after operation, including reducing clinical symptoms, improving mental health, improving the pattern of specific thought and strengthening social application. Comprehensive medical treatment can reduce the recurrence and metastasis of breast cancer as a reference basis for future clinical research. Methods: 60 cases of breast cancer were collected from a cancer care center in Hongkong for 2014-2016 years. All of them were diagnosed as breast cancer by operation and pathology, and 30 cases were divided into experimental and control groups. After cancer, TCM liver depression and phlegm syndrome type of syndrome, the main symptoms include fatigue, insomnia, insomnia, depression / irritability, constipation or loose stool, and dry loose stool, dysphasia or dry, breast distention, hot tide, hyperhidrosis, irregular menstruation, upper limb edema / paralysis, joint pain / lumbago, etc. the.C model questionnaire reflects emotional pressure, self blame and paranoid personality. The Hamilton Depression Scale (HAMD) was a mild depression or above, and the measurement of life of breast cancer patients EORTC-QLQ30 reflects the deficiency of body, role, cognition, emotion and social function. This experiment includes 12 weeks of Chinese medicine course and 4 traditional Chinese medicine psychotherapy, and the experimental group and the control group of breast cancer patients before and after treatment Measurement scale EORTC-QLQ30, TCM clinical symptom questionnaire, Hamilton Depression Scale (HAMD), C personality behavior pattern questionnaire. Statistical method used SPSS22.0 statistics software to establish database, the data were recorded in a unified manner, the data in this study were in the normal distribution, X SD description, P0.05 as the difference was statistically significant. Results: after 12 weeks of traditional Chinese medicine treatment including 12 weeks of Chinese medicine treatment and 4 traditional Chinese medicine psychotherapy, the results were as follows: 1. life weight measurement scale (3.95 + 0.89) and the control group (3.10 + 1.08) in the total healthy quality of life test group (3.10 + 1.08). The experimental group was significantly superior, (P0.05) was statistically significant. In the functional subscale: Cognitive function, emotional function and social function were significantly decreased, reflecting the improvement of anxiety and depression in the contrast control group. The symptoms of insomnia, fatigue and breath were significantly decreased in the clinical syndrome scale, and the experimental group (P0.05) was statistically significant.2. in the TCM clinical symptom quantitative table. The statistical results showed that the main symptoms were tired, sleepless, dreaminess, depression / irritability. The spleen and stomach function was constipated / loose stool, and there was a significant effect (P0.05). The secondary symptoms were significantly improved. Hot flashes, breasts pain, joint pain / low back pain were effective. Clinical symptoms such as hyperhidrosis and menstrual disharmony after chemotherapy or immunotherapy. The effect of upper limb edema / paralysis was less obvious than other symptoms of.3. in 30 cases of TCM clinical symptom experimental group. After 12 weeks of traditional Chinese medicine treatment, 17 cases were effective, 9 cases were effective, 4 cases had no obvious effect in.5, 2 were effective, 7 of which 1 had obvious effect, 3 effective, 3 effect was not obvious.4.HAMD Chinese rice. 21 symptoms of the Depression Scale were scored in the experimental group, after the comprehensive treatment of traditional Chinese medicine, emotional, depression, retardation, and internal blame; the scores were decreased and the experimental group had a significant effect. The anxiety level: the scores of mental anxiety and body anxiety decreased. In the body, the general symptoms, the sleep is not deep or the difficulty was compared. In the control group, the score of.5.C type behavior pattern was obviously improved. The score of the experimental group was less than 6 after the comprehensive treatment of traditional Chinese medicine. The score was increased from 10 patients to 16, and the score was 7-10 from 16 to 11, which reflected the obvious improvement of the patients with the original habit and the tendency to blame and paranoid personality. The patients tended to be open. In this paper, 4 different questionnaires were used to observe the quality of life after breast cancer surgery and the clinical grading changes before and after treatment. The quality of life of breast cancer after operation was obviously superior to the overall quality of life. Improvement, reflecting the optimization of physical, emotional, cognitive, and social functions, and the definition of the quality of life of the WHO (WHO), including physical health, positive cognitive and emotional psychological conditions and normal social relations. After 12 weeks of medicine treatment in the experimental group, the clinical symptoms of traditional Chinese Medicine are tired and sleeplessness. Dream, depressive / annoying irritability, bitter or dry effect; loose stool / constipation, tanning, hot tide, breast pain, joint pain / low back pain are effective; after chemotherapy, the effect of upper limb edema / paralysis is not obvious. After the 4 section of Chinese medicine, the HAMD depression scale showed depression, retardation, and inner blame. The scores of the depression, the anxiety level, the mental anxiety and the body anxiety were also improved, and the physical, systemic symptoms, and sleep were also improved. After 4 sections of psychological counseling in Chinese medicine, the number of patients with type C behavior pattern, that is, the pattern of susceptibility to cancer, was significantly reduced in the experimental group. It indicated that the patients in the experimental group had a suppression, self and paranoid personality tendency, an open attitude, and the ability to enhance self-control and release anxiety and depression. And anger, adjust and transfer painful emotions, especially by sharing your suffering experience, and learn to express their feelings and share openly. In the study, 12 weeks of traditional Chinese medicine and 4 traditional Chinese medicine psychotherapy, clinical symptoms have significant effect, but not comprehensive, or take longer treatment time and follow-up visit, or to cooperate with the other The treatment methods of traditional Chinese medicine, such as acupuncture and moxibustion, discuss the curative effect deeply. In the category of psychological emotion and thinking character pattern, after the psychological treatment of Chinese medicine, the effect is immediately visible. Some light symptoms may have short-term response and feedback. If it is combined with long-term psychological consolidation therapy, the patients can learn and strengthen their own quality constantly and give full play to their benefits. To achieve the purpose of improving and consolidating the quality of life of the patients.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R273

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本文編號：1915097