【摘要】： 目的:綜合治療是目前治療惡性腫瘤的主要方法,其中中醫(yī)藥在綜合治療中的地位日顯凸出。雖然中醫(yī)心理干預(yù)治療惡性腫瘤有一定療效,然而缺乏規(guī)范化治療方案及療效標(biāo)準(zhǔn),尚未在臨床中得到廣泛應(yīng)用。本課題旨在客觀評(píng)價(jià)中藥配合中醫(yī)心理干預(yù)方案在改善腫瘤患者心理狀態(tài)、調(diào)節(jié)免疫功能及提高生活質(zhì)量等方面的臨床療效,并試圖為完善惡性腫瘤綜合治療,并形成初步的規(guī)范化心理治療方案提供臨床依據(jù)。 方法:通過(guò)前瞻性隨機(jī)對(duì)照臨床研究,以心理狀態(tài)評(píng)分(Hamilton抑郁自評(píng)量表計(jì)分)、免疫功能(NK、T細(xì)胞亞群)檢測(cè)指標(biāo)和生活質(zhì)量計(jì)分(EORTC QLQ-C30(version 3)生活質(zhì)量調(diào)查問(wèn)卷)為重點(diǎn)研究指標(biāo),在北京中醫(yī)藥大學(xué)東直門醫(yī)院和中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院觀察了符合納入病例標(biāo)準(zhǔn)的53例惡性腫瘤患者,按不平衡指數(shù)最小的分配原則,隨機(jī)分配到治療組及對(duì)照組,兩組比例為1:1。對(duì)照組:采用常規(guī)治療,包括化療、對(duì)癥治療和支持治療等。治療組:在對(duì)照組治療基礎(chǔ)上,增加中藥配合中醫(yī)心理干預(yù)療法。全部病例均連續(xù)治療14天為一個(gè)治療周期。每組分別觀察治療1個(gè)周期。統(tǒng)計(jì)分析采用SPSS11.0統(tǒng)計(jì)分析軟件進(jìn)行計(jì)算。組間資料兩兩比較采用t檢驗(yàn)。治療前后比較用配對(duì)t檢驗(yàn)。 結(jié)果:中醫(yī)心理干預(yù)方案對(duì)于改善腫瘤患者的心理狀態(tài)、生活質(zhì)量具有明顯作用,在情感關(guān)系、免疫指標(biāo)等方面的改善較對(duì)照組均有統(tǒng)計(jì)學(xué)意義。①中醫(yī)心理干預(yù)治療組第8天測(cè)評(píng),與療前比較,Hamilton評(píng)分有所上升,但無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);第15天測(cè)評(píng),Hamilton評(píng)分明顯下降,與療前相比有統(tǒng)計(jì)學(xué)意義(P0.01)。而常規(guī)治療對(duì)照組中,療后兩次測(cè)評(píng)與治療前比較,Hamilton評(píng)分略有上升,無(wú)統(tǒng)計(jì)學(xué)意義。②中醫(yī)心理干預(yù)治療組第8天測(cè)評(píng),8例QOL明顯改善,與對(duì)照組(僅1例改善)比較,具有統(tǒng)計(jì)學(xué)意義(P0.01);第15天測(cè)評(píng),治療組QOL評(píng)分明顯上升,生活質(zhì)量明顯提高者達(dá)到22例,與常規(guī)治療對(duì)照組(QOL改善者僅有2例)相比,有效率分別為75.9%和8.3%,具有統(tǒng)計(jì)學(xué)意義(P0.001)。③中醫(yī)心理干預(yù)治療組第15天測(cè)評(píng)免疫功能,治療組與對(duì)照組相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有統(tǒng)計(jì)學(xué)意義(P0.05),治療組NK細(xì)胞療后雖比對(duì)照組上升,但無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療組治療前、療后相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論:以調(diào)暢情志為主的中醫(yī)心理干預(yù)治療可以作為腫瘤綜合治療的一部分,對(duì)提高腫瘤患者生活質(zhì)量方面大有裨益,反映出中藥配合心理治療方案在一定程度上調(diào)節(jié)機(jī)體免疫功能的一種趨勢(shì)。本課題的研究結(jié)果顯示中醫(yī)心理治療可以使腫瘤患者心理狀態(tài)改善,生活質(zhì)量提高,免疫指標(biāo)好轉(zhuǎn),三者之間存在直接相關(guān)性。提示在腫瘤患者綜合治療中,中藥配合心理干預(yù)療法不但有助于控制腫瘤的發(fā)展,還具有一定的社會(huì)和經(jīng)濟(jì)效應(yīng),該方案值得進(jìn)一步探索與完善。
[Abstract]:Objective: Comprehensive treatment is the main method for the treatment of malignant tumor, in which the status date of traditional Chinese medicine is prominent. Although traditional Chinese medicine psychological intervention is effective in treating malignant tumor, there is a lack of standardized treatment plan and curative effect standard, which has not been widely used in clinic. The objective of this study is to objectively evaluate the clinical efficacy of traditional Chinese medicine combined with traditional Chinese medicine psychological intervention program in improving the mental state of tumor patients, regulating the immune function and improving the quality of life, and try to improve the comprehensive treatment of malignant tumor. and forms a preliminary standardized psychotherapy scheme to provide a clinical basis. Methods: A prospective randomized controlled clinical study was conducted to evaluate the mental state score (Hamilton depression self-rating scale), immune function (NK, T cell subgroup) and quality of life (EORTC QLQ-C30 (version 3)). In order to study the indexes, 53 patients with malignant tumor were randomly assigned to the treatment group and the control group according to the principle of the minimum balance index in the East-direct-Door Hospital of Beijing University of Traditional Chinese Medicine and the Cancer Hospital of Chinese Academy of Medical Sciences. The proportion of the groups was 1: 1. The control group: routine treatment, including chemotherapy, symptomatic treatment, Therapy and support therapy, etc. Treatment group: on the basis of control group treatment, increase the coordination of traditional Chinese medicine Medical psychological intervention therapy. All cases were continuously treated for 14 days For a treatment cycle, each group views For 1 period of treatment, SPSS 11.0 was used for statistical analysis. The software is calculated. The inter-group data are two t-test was used to compare the treatment before and after treatment. Results: The psychological intervention program of traditional Chinese medicine has obvious effect on improving the mental state and quality of life of patients with tumor. Compared with the control group, the improvement of the surface was statistically significant. Compared with the control group, the Hamilton score increased, but there was no statistical significance (P0.05). There was statistical significance (P0.01). Compared with the conventional treatment group, the two tests were compared with the pre-treatment, and Hamilt On the 8th day of the treatment group, 8 cases of QOL were significantly improved, compared with the control group (1 case only). The score of QOL of the treatment group was significantly higher than that in the control group (P <0.01). The effective rate was 75.9% and 80.3%, respectively. Compared with the control group, CD3 +, CD4 +, CD4 +/ CD8 + both increased and CD8 + decreased in the treatment group compared with the control group. But there was no statistical significance (P0.05). CD3 +, CD4 +, CD4 +/ CD8 + both increased and CD8 + decreased before and after treatment. Conclusion: Traditional Chinese medicine psychological intervention can be used as a part of the comprehensive treatment of tumor, which can improve the quality of life of patients with tumor, and reflect the matching psychology of traditional Chinese medicine. The research result shows that the psychological state of the tumor patients can be improved and the life of the patients can be improved. It is suggested that traditional Chinese medicine combined with psychological intervention therapy not only can help control the development of tumor, but also has one.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2007
【分類號(hào)】：R273;R395.5

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