發(fā)布時(shí)間：2018-06-26 20:51

  本文選題：刺絡(luò)拔罐 + 臨床治療　； 參考：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的客觀評(píng)價(jià)刺絡(luò)拔罐治療乳腺癌術(shù)后上肢淋巴水腫的臨床療效,為乳腺癌術(shù)后淋巴水腫患者提供一個(gè)方便可靠的中醫(yī)治療方案,為刺絡(luò)拔罐治療乳腺癌術(shù)后上肢水腫的規(guī)范化操作提供技術(shù)支持。方法將75例乳腺癌術(shù)后上肢水腫患者隨機(jī)分為兩組,其中對(duì)照組25例,治療組50例；治療組給予刺絡(luò)拔罐,同時(shí)行上肢功能鍛煉操,刺絡(luò)拔罐的部位選擇為患側(cè)上肢手三陰經(jīng)和手三陽(yáng)經(jīng),每次治療選取1-2條經(jīng)絡(luò),沿此經(jīng)絡(luò)在皮下結(jié)節(jié)處、最腫脹部位梅花針點(diǎn)刺出血后拔火罐；同時(shí)循背部雙側(cè)膀胱經(jīng)閃罐兩遍后,選取肺俞穴及脾俞穴點(diǎn)刺出血后拔火罐,沿膀胱經(jīng)其它部位僅拔罐不點(diǎn)刺出血,每個(gè)部位留罐10分鐘；對(duì)照組單純行上肢功能鍛煉操。兩組治療周期均為50天,上肢功能鍛煉操每天進(jìn)行,每次30分鐘,治療組刺絡(luò)拔罐5天行一次治療,共進(jìn)行10次治療。主要療效評(píng)價(jià)指標(biāo)為患肢臂圍變化,5次訪視分別記錄患側(cè)上肢腕橫紋、腕上lOcm、肘橫紋、肘上l0cm處的臂圍,將兩組治療前后的臂圍平均值及差值進(jìn)行分析對(duì)比；次要療效評(píng)價(jià)指標(biāo)包括有效指數(shù)、肩關(guān)節(jié)活動(dòng)度、疼痛評(píng)分、患肢肌力分級(jí)、生活質(zhì)量評(píng)分及安全性評(píng)價(jià)。所有研究數(shù)據(jù)及結(jié)果均采用SPSS20.0統(tǒng)計(jì)軟件進(jìn)行計(jì)算分析,若P0.05則認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果通過(guò)50天的臨床療效觀察,治療后兩組臂圍的均值及差值P0.05,差異具有統(tǒng)計(jì)學(xué)意義,其中治療組臂圍平均減小1.21cm,對(duì)照組臂圍平均減小0.58cm,治療組的療效明顯優(yōu)于對(duì)照組；患肢腕橫紋處及腕橫紋上l0cm處,組間比較其均值及差值具有統(tǒng)計(jì)學(xué)意義,治療組在此兩點(diǎn)處的臂圍縮小較對(duì)照組明顯；治療組與對(duì)照組的總有效率分別為95.8%和58.3%；在改善肩關(guān)節(jié)功能活動(dòng)方面,組間比較P0.05,兩組之間無(wú)差異；但是兩組治療前后的組內(nèi)比較,四個(gè)角度的活動(dòng)均有所改善,差異具有統(tǒng)計(jì)學(xué)意義；在改善疼痛方面,組內(nèi)比較P0.05,兩組患者治療后疼痛均較治療前減輕,組間比較P0.05,治療組優(yōu)于對(duì)照組；在生活質(zhì)量方面,比較治療組與對(duì)照組治療后QOL總分,得出P0.05,差異具有統(tǒng)計(jì)學(xué)意義,說(shuō)明在提高患者生活質(zhì)量方面,治療組明顯優(yōu)于對(duì)照組,而生活質(zhì)量的提高具體表現(xiàn)在“改善睡眠”、“緩解疲乏”“減輕疼痛”三個(gè)方面；安全評(píng)價(jià)方面,兩組患者均未出現(xiàn)不良事件。結(jié)論刺絡(luò)拔罐法可有效減輕患肢水腫,尤其對(duì)前臂水腫的消退有較突出的療效；刺絡(luò)拔罐可以改善肩關(guān)節(jié)活動(dòng)度,能更有效的緩解上肢淋巴水腫所引起的肢體疼痛,同時(shí)可以改善睡眠,緩解疲乏從而提高乳腺癌術(shù)后上肢水腫患者的生活質(zhì)量,并且刺絡(luò)拔罐法操作簡(jiǎn)便、費(fèi)用低廉、安全性高,易于被患者接受,是一種值得在臨床上推廣應(yīng)用的治療乳腺癌術(shù)后上肢水腫的可靠方案。
[Abstract]:Objective to evaluate objectively the clinical effect of pricking and cupping on upper limb lymphedema after operation of breast cancer, and to provide a convenient and reliable Chinese medicine treatment scheme for postoperative lymphedema patients of breast cancer. To provide technical support for standardized operation of pricking and cupping for upper limb edema after breast cancer operation. Methods Seventy-five patients with upper limb edema after breast cancer operation were randomly divided into two groups: the control group (n = 25) and the treatment group (n = 50). The position of pricking and cupping was selected as three yin meridians and three yang meridians of the affected upper limbs. 1-2 meridians were selected for each treatment, along which the meridians were placed at the subcutaneous nodule, and the most swollen part was pricked with plum needle to prick the cupping. At the same time, the cupping of both sides of the bladder was followed twice, and the cupping was taken out after pricking and bleeding at the points of Feshu and Peshu, and only the cupping was not punctured along the other parts of the bladder, and the cupping was kept in each part for 10 minutes, while in the control group, the function of upper limbs was exercised only. The treatment period of the two groups was 50 days. The upper limb functional exercise was performed every day for 30 minutes. The treatment group was treated once for 5 days and 10 times. The main outcome indexes were as follows: the changes of arm circumference of the affected limbs were recorded by 5 visits. The transverse striae of wrist, lOcm on wrist, transverse striae of elbow and arm circumference of l0cm on elbow were recorded respectively. The mean value and difference of arm circumference before and after treatment were analyzed and compared between the two groups. Secondary efficacy indicators included effectiveness index, shoulder motion, pain score, muscle strength grading of affected limbs, quality of life score and safety evaluation. All the data and results were calculated and analyzed by SPSS 20.0 statistical software. If P0.05, the difference was statistically significant. Results after 50 days of treatment, the mean value and difference of arm circumference were significantly different between the two groups (P 0.05). The average arm circumference of the treatment group decreased 1.21 cm, and the average arm circumference of the control group decreased 0.58 cm. The curative effect of the treatment group was significantly better than that of the control group. The mean value and difference between the two groups were statistically significant, and the total effective rates of the treatment group and the control group were 95.8% and 58.3%, respectively, and the reduction of the arm circumference between the two groups was more obvious than that in the control group, and the total effective rates of the treatment group and the control group were 95.8% and 58.3%, respectively. In terms of improving the functional activity of shoulder joint, there was no difference between the two groups in terms of P0.05, but the activity of four angles was improved in both groups before and after treatment, and the difference was statistically significant. Compared with P0.05, the pain of the two groups after treatment was less than that before treatment, the comparison between the two groups was P0.05, the treatment group was better than the control group, in terms of quality of life, the total score of QOL after treatment was compared between the treatment group and the control group, and the difference was statistically significant. It shows that the treatment group is obviously superior to the control group in improving the quality of life of the patients, and the improvement of the quality of life is manifested in three aspects: "improving sleep", "relieving fatigue" and "relieving pain"; There were no adverse events in both groups. Conclusion the method of pricking and cupping can effectively reduce the edema of the affected limb, especially the abatement of the edema of the forearm, and the pricking and cupping can improve the motion of the shoulder joint and relieve the limb pain caused by lymphedema of the upper limb more effectively. At the same time, it can improve sleep, relieve fatigue and improve the quality of life of patients with edema of upper extremity after breast cancer operation, and the method of puncture and cupping is easy to operate, low cost, high safety and easy to be accepted by patients. It is a reliable method for the treatment of upper limb edema after breast cancer surgery.
【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】：2016
【分類號(hào)】：R246.5

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