本文選題：乳腺癌相關(guān)性淋巴水腫 + 溫和灸�。� 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的:本研究旨在觀察溫和灸療法對(duì)乳腺癌相關(guān)性淋巴水腫的治療效果,為溫和灸治療乳腺癌相關(guān)性淋巴水腫患者提供有效的臨床證據(jù)。研究方法:將納入研究的48例乳腺癌相關(guān)性淋巴水腫患者隨機(jī)分為試驗(yàn)組和對(duì)照組。試驗(yàn)組24例患者采用溫和灸治療,對(duì)照組24例患者采用氣壓循環(huán)驅(qū)動(dòng)治療,以4周為一個(gè)療程,每周進(jìn)行2次治療。每周測(cè)量并記錄患肢臂圍,患肢自覺(jué)腫脹程度和患肢肌力,并在療程開(kāi)始和結(jié)束時(shí)分別記錄患者生活質(zhì)量評(píng)分及疲乏評(píng)分。將結(jié)果進(jìn)行統(tǒng)計(jì)分析,觀察兩組治療前后的臂圍平均值及差值、腫脹感、肌力分級(jí),生活質(zhì)量評(píng)分及疲乏評(píng)分。所有研究數(shù)據(jù)采用SPSS 20.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,若P0.05則認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)果:通過(guò)4周的臨床觀察,兩組患者患肢臂圍均較治療前縮小,組間及組內(nèi)前后比較P0.05,差異具有統(tǒng)計(jì)學(xué)意義。試驗(yàn)組與對(duì)照組臂圍分別減小1.13cm和0.61cm,試驗(yàn)組療效優(yōu)于對(duì)照組;組間效應(yīng)方差分析,從第一次訪視開(kāi)始P0.05,具有統(tǒng)汁學(xué)差異,治療一周后試驗(yàn)組的療效開(kāi)始優(yōu)于對(duì)照組;治療后兩組患者在肘橫紋及肘橫紋上1Ocm處組間比較具有統(tǒng)計(jì)學(xué)差異,試驗(yàn)組在此兩點(diǎn)處臂圍改善較對(duì)照組明顯;自覺(jué)腫脹感評(píng)分組內(nèi)前后比較P0.05,兩組患者治療后腫脹感均較治療前減輕,組間比較P0.05,試驗(yàn)組優(yōu)于對(duì)照組;患者生活質(zhì)量總評(píng)分組間比較P0.05,差異具有統(tǒng)計(jì)學(xué)意義,試驗(yàn)組優(yōu)于對(duì)照組,生活質(zhì)量的條目改善具體表現(xiàn)在"疲乏"、"對(duì)治療的態(tài)度"、"治療的副作用"三個(gè)方面;患者疲乏感評(píng)分方面,治療后兩組之間在總體評(píng)分及各維度評(píng)分上無(wú)顯著統(tǒng)計(jì)學(xué)差異;組內(nèi)前后比較,在"行為"、"情緒"、"感覺(jué)","認(rèn)知"四個(gè)維度評(píng)分及疲乏總評(píng)分上P0.05,統(tǒng)計(jì)學(xué)差異顯著,試驗(yàn)組效果明顯。安全性評(píng)價(jià)上,一例患者因溫和灸治療導(dǎo)致患肢上臂出現(xiàn)潮紅、瘙癢皮膚過(guò)敏反應(yīng)。研究結(jié)論:分析研究結(jié)果表明,兩種療法均能有效的改善上肢淋巴水腫。溫和灸治療相比氣壓循環(huán)驅(qū)動(dòng)治療在縮減患肢臂圍上更明顯;溫和灸能使上肢淋巴水腫的治療更快起效,并對(duì)上肢淋巴水腫引起的肢體腫脹感緩解更明顯;溫和灸可以提高患者的生活質(zhì)量,從多維度減輕患者疲乏感同時(shí)具有相對(duì)較高的安全性。溫和灸療效確切,操作相對(duì)簡(jiǎn)便、成本低廉,患者接受程度高,是一種值得在臨床上推廣的治療乳腺癌相關(guān)性淋巴水腫的方案。
[Abstract]:Objective: to observe the therapeutic effect of mild moxibustion on breast cancer associated lymphedema and to provide effective clinical evidence for mild moxibustion in the treatment of breast cancer associated lymphedema.Methods: 48 patients with breast cancer associated lymphedema were randomly divided into trial group and control group.The experimental group (n = 24) was treated with mild moxibustion, while the control group (n = 24) was treated with pneumatic circulatory drive therapy for 4 weeks as a course of treatment, twice a week.The circumference of the affected arm, the degree of swelling and muscle strength of the affected limb were measured and recorded weekly. The quality of life score and fatigue score were recorded at the beginning and the end of the course of treatment.The average value and difference of arm circumference, swelling feeling, muscle strength grading, quality of life score and fatigue score were observed before and after treatment.All the data were analyzed by SPSS 20.0 statistical software. If P0.05, the difference was statistically significant.Results: after 4 weeks of clinical observation, the arm circumference of the two groups was smaller than that before treatment, and the difference between the two groups was statistically significant (P 0.05).The arm circumference of experimental group and control group decreased 1.13cm and 0.61cm respectively, the curative effect of test group was better than that of control group, the variance analysis of effect between groups, P0.05 from the first visit, had the difference of juicing, and the curative effect of test group was better than that of control group after one week of treatment.After treatment, there were significant differences between the two groups in the 1Ocm of the cubital stria and on the cubital stria, and the improvement of the arm circumference at these two points in the trial group was more obvious than that in the control group.The scores of subjective swelling were significantly lower in both groups than before and after treatment (P 0.05), and were better in the test group than in the control group, and the difference was statistically significant in the total score of patients' quality of life (P0.05), the difference between the two groups was statistically significant (P 0.05), and that between the two groups was significantly higher than that in the control group (P 0.05).The improvement of quality of life items in the trial group was better than that in the control group in three aspects: "fatigue", "attitude towards treatment", "side effects of treatment", and scores of patients' fatigue.After treatment, there was no significant difference between the two groups in the total score and the score of each dimension, the difference was significant in the scores of "behavior", "emotion", "feeling", "cognition" and the total score of fatigue between the two groups before and after treatment (P 0.05).The effect of test group was obvious.In safety evaluation, one patient suffered from redness and pruritus skin allergic reaction due to mild moxibustion treatment.Conclusion: the results show that both treatments can effectively improve upper limb lymphedema.Mild moxibustion treatment was more obvious than pneumatic circulatory drive therapy in reducing the circumference of the affected limb, mild moxibustion could make the treatment of upper limb lymphedema more effective, and relieve the swelling of upper limb caused by lymphedema more obviously.Mild moxibustion can improve the quality of life of patients.Mild moxibustion has the advantages of accurate curative effect, relatively simple operation, low cost and high acceptance of patients. It is worth popularizing in clinical treatment of breast cancer associated lymphedema.
【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】：2017
【分類號(hào)】：R246.5

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