本文選題：惡性腹水 + 中藥消水方離子導(dǎo)入　； 參考：《安徽中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注治療惡性腹水的療效,探討中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注的方法對(duì)于腫瘤患者的腹水量、腹圍、24h尿量、腹水腫瘤指標(biāo)、不良反應(yīng)等方面的情況,以及提高生活質(zhì)量的影響,為今后治療惡性腹水的臨床研究提供循證依據(jù)。方法:觀察安徽省立醫(yī)院中醫(yī)腫瘤科2015年1月至2016年12月收治的惡性腹水患者,將符合納入標(biāo)準(zhǔn)的45例患者按住院先后隨機(jī)分為治療組23人及對(duì)照組22人。治療組采用中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注治療;對(duì)照組采用單純順鉑腹腔灌注化療,兩周為一個(gè)療程,兩個(gè)療程后評(píng)估患者腹水量、24小時(shí)尿量、腹圍、腹水腫瘤指標(biāo)、不良反應(yīng)、臨床癥狀及生活質(zhì)量變化情況,應(yīng)用統(tǒng)計(jì)學(xué)分析,得出最后的臨床療效。結(jié)果:1.腹水療效指標(biāo):治療組完全緩解2人,部分緩解17人,穩(wěn)定3人,進(jìn)展1人,有效率83%;對(duì)照組完全緩解2人,部分緩解7人,穩(wěn)定5人,進(jìn)展8人,有效率41%,兩組有效率對(duì)比,治療組高于對(duì)照組,c2=9.63,P0.05,兩組具有明顯的差異,提示采用本研究方法較單純順鉑腹腔灌注療效較突出。兩組腹水患者在治療前后B超定位下腹水均有所下降,治療組治療前腹水量為94.53±18.91mm,治療后67.17±12.44mm;對(duì)照組治療前89.91±20.28mm,治療后79.09±23.45mm。經(jīng)t檢驗(yàn)分析后得出P0.05,兩組在統(tǒng)計(jì)學(xué)上有明顯差異,說明治療組腹水消退較對(duì)照組明顯。2.腹圍:兩組腹圍在治療后均有所降低,治療組治療前腹圍為98.87±7.11cm,治療后腹圍為66±12.74cm;對(duì)照組腹圍治療前為106.91±13.01cm,治療后腹圍為90.86±10.97cm。兩組治療后經(jīng)t檢驗(yàn)得出P0.01,差異有統(tǒng)計(jì)學(xué)意義,結(jié)果提示治療組腹圍較對(duì)照組減少明顯。3.24h尿量:兩組尿量在治療后均有不同程度的增加,治療組治療前尿量為361.30±125.02mL,治療后尿量為723.48±163.81mL;對(duì)照組治療前尿量為358.64±96.53mL,治療后尿量為608.64±140.08mL。經(jīng)統(tǒng)計(jì)學(xué)分析,t=2.52,P0.05,兩組在尿量上存在明顯的差異,結(jié)果提示治療組治療后尿量較對(duì)照組增加明顯。4.腹水腫瘤指標(biāo):治療組腫瘤指標(biāo)降低8人,穩(wěn)定13人,增加2人,改善率91%;對(duì)照組腫瘤指標(biāo)降低3人,穩(wěn)定10人,增加9人,改善率59%,經(jīng)統(tǒng)計(jì)學(xué)分析,c2=6.32,P0.05,兩組腹水指標(biāo)具有統(tǒng)計(jì)學(xué)意義,治療組較對(duì)照組腹水減少明顯。5.臨床癥狀變化情況:臨床癥狀積分由腹脹、消瘦、飲食、睡眠四方面的相加組成。兩組患者在治療后癥狀均較前有所改善,治療組治療前為29.70±5.55,治療后為20.40±3.70;對(duì)照組治療前為27.05±5.67,治療后為23.35±4.27。經(jīng)統(tǒng)計(jì)學(xué)分析,t=2.48,P0.05,兩組具有明顯的差異,治療組較對(duì)照組臨床癥狀改善明顯。6.生活質(zhì)量變化情況:治療組提高8人,穩(wěn)定14人,降低1人,改善率96%;對(duì)照組提高4人,穩(wěn)定12人,降低6人,改善率72%。經(jīng)卡方檢驗(yàn)分析,c2=7.68,P0.05,兩組在統(tǒng)計(jì)學(xué)上存在明顯差異,結(jié)果顯示治療組治療前后生活質(zhì)量明顯高于對(duì)照組。兩組KPS評(píng)分比較,治療組升高7人,穩(wěn)定14人,降低3人,改善率91%;對(duì)照組升高3人,穩(wěn)定8人,降低11人,改善率50%,經(jīng)卡方檢驗(yàn)得出c2=7.73,P0.05,兩組在統(tǒng)計(jì)學(xué)上有明顯差異,治療組較對(duì)照組生活質(zhì)量提高。7.不良反應(yīng):兩組患者在安全性方面無明顯差異,僅有部分出現(xiàn)輕度骨髓抑制、皮疹、發(fā)熱等不良反應(yīng),停藥后不再出現(xiàn)。結(jié)論:1.采用中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注的方法較單純采用順鉑腹腔灌注化療的方法治療惡性腹水的療效顯著;2.中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注組在飲食、睡眠、腹脹、消瘦等方面較對(duì)照組有所改善;3.中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注組在腹圍方面,與對(duì)照組相比降低明顯;在尿量方面,較對(duì)照組增加明顯;4.中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注組在生活質(zhì)量提高方面明顯高于對(duì)照組;5.中藥消水方離子導(dǎo)入聯(lián)合順鉑腹腔灌注組在安全性方面,未出現(xiàn)明顯的不良反應(yīng),且成本低,表現(xiàn)出較好的安全性及應(yīng)用價(jià)值。
[Abstract]:Objective: To observe the effect of iiontophoresis and cisplatin intraperitoneal perfusion in the treatment of malignant ascites, and to explore the effect of the method of iiontophoresis combined with cisplatin intraperitoneal perfusion on the volume of ascites, abdominal circumference, 24h urine volume, ascites tumor index, adverse reaction and so on, as well as the effect of improving the quality of life. The clinical study of malignant ascites provides evidence-based evidence. Methods: the patients with malignant ascites from the Department of oncology of the Anhui Provincial Hospital from January 2015 to December 2016 were observed, and 45 patients were randomly divided into 23 patients and 22 control groups according to the admission criteria. The control group was treated with intraperitoneal perfusion. The control group was treated with simple cisplatin intraperitoneal perfusion chemotherapy, two weeks as a course of treatment. After two courses, the patients' ascites, 24 hours urine volume, abdominal circumference, ascites tumor index, adverse reaction, clinical symptoms and quality of life were changed, and the final clinical efficacy was obtained by statistical analysis. Results: 1. results were as follows: the curative effect index of 1. ascites: The treatment group completely relieved 2 people, partially relieved 17 people, stable 3 people, 1 people, and 83%. The control group was completely relieved of 2, partly relieved, 7, 5, 8, and 41%, two. The treatment group was higher than the control group, c2=9.63, P0.05, and two group had obvious differences, suggesting the use of this study method compared with simple cisplatin intraperitoneal irrigation. The abdominal water in the two groups of the two groups of abdominal water decreased before and after the treatment. The abdominal water of the treatment group was 94.53 + 18.91mm before treatment and 67.17 + 12.44mm after treatment. The control group was 89.91 + 20.28mm before treatment, and 79.09 + 23.45mm. after the treatment was analyzed by t test. The two groups were statistically significant differences, indicating the abdomen of the treatment group. The abdominal circumference of the two groups was lower than that in the control group. The abdominal circumference of the two groups decreased after treatment. The abdominal circumference of the treatment group was 98.87 + 7.11cm before treatment. The abdominal circumference was 66 + 12.74cm after treatment. The control group was 106.91 + 13.01cm before the abdominal circumference, and the abdominal circumference was 90.86 + 10.97cm. two after treatment. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant. The difference was statistically significant, the result was a statistical significance, the result was a statistical significance, the result was a statistical significance, the result hints that the difference was statistically significant, the result was a statistical significance, the result hints that the difference was statistically significant, the result was a statistical significance, the result was a statistical significance, the result Compared with the control group, the abdominal circumference of the treatment group decreased significantly.3.24h urine volume: the urine volume in the two groups increased in different degrees after treatment. The urine volume of the treatment group was 361.30 + 125.02mL before treatment, and the urine volume after treatment was 723.48 + 163.81mL; the urine volume of the control group was 358.64 + 96.53mL before treatment, and the post treatment urine volume was 608.64 + 140.08mL., t=2.52, P0.05, two groups. There was a significant difference in the urine volume. The results suggested that the urine volume of the treatment group was increased by.4. ascites tumor index in the treatment group: the tumor index of the treatment group was reduced by 8 people, 13 people were stable, 2 increased, the rate of improvement was 91%. The tumor index of the control group was 3, 10 stable, 9, and 59%, with statistical analysis, c2=6.32, P0.05, and two groups of ascites. The index had statistical significance, the treatment group compared with the control group, the ascites decreased significantly.5. clinical symptoms: the clinical symptom score was composed of four aspects of abdominal distention, emaciation, diet and sleep. The two groups were improved after treatment, 29.70 + 5.55 before treatment, 20.40 3.70 after treatment, and 2 in the control group before treatment. 7.05 + 5.67, after the treatment was 23.35 + 4.27. by statistical analysis, t=2.48, P0.05, two groups have obvious differences, compared with the control group, the clinical symptoms improved significantly.6. quality of life changes: the treatment group increased 8, the stability of 14 people, 1, the improvement rate 96%; the control group increased 4, 12 people, reduced 6, the improvement rate 72%. test score of the 72%. score Analysis, c2=7.68, P0.05, the two groups were statistically significant differences, the results showed that the quality of life in the treatment group was significantly higher than that of the control group. Compared with the two groups, the KPS score of the treatment group was 7, 14, 3, and 91%, and 3 in the control group, 8, 11, 50%, and c2=7.73, P0.05, two. There was significant difference in statistics. The quality of life in the treatment group was higher than that of the control group.7.. There was no significant difference in safety between the two groups. There were only some mild myelosuppression, rash, fever and other adverse reactions, and no longer appeared after the withdrawal. Conclusion: 1. the method of combining cisplatin combined with cisplatin was used. The effect of cisplatin intraperitoneal perfusion chemotherapy on malignant ascites was significantly better than that of the control group. 2. the iiontophoresis combined with cisplatin intraperitoneal perfusion group was better than the control group in the diet, sleep, abdominal distention and emaciation, and 3. the iiontophoresis combined with cisplatin intraperitoneal perfusion group in abdominal circumference, compared with the control group. Obviously, in the urine volume, it was more obvious than the control group; 4. the iiontophoresis combined with cisplatin intraperitoneal perfusion group was obviously higher than the control group. 5. the ionconium ion introduction combined with cisplatin intraperitoneal perfusion group had no obvious adverse reaction in the safety of the cisplatin intraperitoneal perfusion group, and the cost was low, and it showed good safety. And application value.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R730.5

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