【作者】 张伟；

【导师】 李晶；

【作者基本信息】 河北医科大学 ， 中西医结合基础， 2018， 硕士

【摘要】 目的:探索内服加味身痛逐瘀汤配合刺血拔罐外治的新型治疗模式对乳腺癌术后上肢肿胀的治疗作用,通过观察比较,是否可以减轻乳腺癌术后上肢肿胀;是否可以改善患者临床症状,提高生活质量,为进一步提高中医药在乳腺癌术后上肢肿胀治疗中的积极作用。方法:本课题采用随机对照的临床研究,严格按照诊断及纳入、排除标准,共收集河北医科大学第四医院乳腺外科、中医科2017年1月至2018年1月门诊乳腺癌术后上肢肿患者,共67例,其中试验组35例,对照组32例。全部病例符合乳腺癌术后上肢肿的诊断标准,可纳入临床试验。按照随机抽签,分为试验组和对照组。对照组入组当日开始单纯术后上肢功能锻炼。患侧上肢尽可能上举,卧位时应避免患肢受压,将其垫高置于高于前胸壁水平。患肢戴有张力的袖套,尽量减轻体重。配合按摩,自远侧向近侧用一定压力推移,每次推压15min以上,每日3次。尽量避免患肢负重或测量血压、输液、抽血等;试验组在对照组治疗基础上,口服中药加味身痛逐瘀汤配合刺血拔罐。两组患者分别于观察治疗前及治疗8周后进行臂围周径比较、疼痛评分比较、有效率比较、生存质量量表评分比较。结果:1.两组患者,试验组周径各测量点治疗前后比较,有统计学差异(P<0.05)。对照组周径各测量点治疗前后比较,有统计学差异(P<0.05)。两种治疗方法对于改善患者上述指标均有效。治疗前两组之间比较,差异无统计学意义(P>0.05);治疗后两组间比较,在腕横纹、腕横纹上10cm、肘横纹上10cm处,差异有统计学意义(P<0.05),即试验组疗效优于对照组;在掌围和肘横纹的测量处,差异没有统计学意义(P>0.05),即试验组与对照组上疗效差异并不明显。2.两组疼痛评分比较,试验组治疗前后疼痛VAS评分,差异有统计学意义(P<0.05);对照组治疗前后疼痛VAS评分,差异有统计学意义(P<0.05)。治疗后两组间比较,差异有统计学意义(P<0.05),即试验组在改善疼痛方面优于对照组。3.经治疗观察后两组比较,试验组35例患者中,8周后治疗显效的0例,显效率达0%;有效30例,有效率达85.7%,无效5例;无效率占14.3%。对照组32例患者,8周治疗后出现显效0例,显效率0%,有效20例,有效率62.5%,无效12例,无效率占37.5%。两组患者在治疗上肢肿胀的有效指数方面,经秩和检验可知,Z=2.165,P=0.03<0.05,差异有统计学意义(P<0.05),即试验组的治疗效果优于对照组。4.治疗前两组间在QOL评分比较,差异无统计学差异(P>0.05),即两组QOL评分具有可比性;两组治疗前后组内QOL评分比较,差异有统计学意义(P<0.05),即两组患者功能状态均有所改善,但两组治疗后组间比较,差异有统计学意义(P<0.05)即试验组在改善患者功能状态方面优于对照组。结论:1.加味身痛逐瘀汤配合刺血拔罐治疗乳腺癌术后上肢肿,能更有效减轻水肿;能明显缓解病人肢体疼痛;有效率优于对照组。2.加味身痛逐瘀汤配合刺血拔罐治疗,提高乳腺癌术后上肢肿患者生活质量。更多还原

【Abstract】 Objective:To explore the therapeutic effect of the new mode of treatment on upper limb swelling after breast cancer.By comparison,is it possible to reduce the swelling of the upper limb after breast cancer surgery.To explore whether it can improve the patient’s clinical symptoms and improve the quality of life.To further improve the Chinese medicine,breast cancer after the swelling of the upper limb,the active effect in the treatment.Methods: This subject uses a randomizd controlled clinical study.According to the diagnostic and inclusion criteria,a total of 67 patients with upper limb swelling after breast cancer surgery from January 2017 to January 2018 in Department of traditional Chinese medicine,Fourth Hospital of Hebei Medical University were collected.Of the experimental group 35 cases,of the control group were 32 cases.All the medical records are in accordance with the diagnostic criteria for the upper limb swelling after breast cancer surgery,which can be included in the clinical trials.According to the random drow,it was divided into the experimental group and the contral group.The control group entered the group,and it began to be simple at the same day,and the functional exercise of the upper limb after the operation.The upper limb of the affected side should be lifted as much as possible,and the pressure of the affected limb should be avoided in the supine position,and the cushion is high,as far as the level of the front chest.The side limbs,with the tension sleeve,try to reduce the weight.In combination with massage,a certain pressure is used from the far side of the lateral side with a push of pressure for more than 15 minutes each time,three times a day.Try to avoid the weight of the side limbs or measure blood pressure transfusion and so on.The treatment group in the control group based on the treatment of oral Jiawei Shentong Zhuyutang,combined with blood letting puncture and cupping.The two groups were followed up.The two groups were compared before and after eight weeks of treatment,respectively.Comparison content,including,upper arm circumference,pain score,efficiency,quality of life scale score.Rrsults:1.The circumference of the test group was statistically different before and after treatment(P<0.05).Control group circumference diameter measurement points before and after treatment,there was a significant difference(P<0.05).The two treatments are effective in improving the above indicators.There was no significant difference between the two groups before the treatment(P > 0.05),and the difference between the two groups after the treatment was statistically significant(P < 0.05)on the wrist transverse lines,the wrist transverse lines and the elbow transverse lines(P < 0.05),that is,the effect of the test group was better than the control group,and there was no statistical difference between the test group and the measurement of the palmar and elbow transverse lines(P > 0.05),that is,the difference between the experimental group and the control group is not obvious.2.Two groups of pain scores,the test group before and after the treatment of pain VAS score,the difference was statistically significant(P<0.05),the control group before and after the pain VAS score,the difference was statistically significant(P<0.05).After treatment,the difference between the two groups was statistically significant(P < 0.05),that is,the experimental group was better than the control group in improving pain.3.After treatment,the two groups were observed and compared.In the 35 cases of the experimental group,eight weeks later,the effective rate was 0%,effective rate was 30,the effective rate was 85.7%,and the 5 cases were invalid.The inefficency accounted for 14.3%.After eight weeks of 32 patients in the control group,there was no obvious cases after treatment,the effective rate was 0%,20 effective,62.5% effective,and 12 ineffective ineffective rates of 37.5%.Two groups of patients in the treatment of upper extremity swelling effective index aspect,ranke sum test,we know,Z=2.165,P=0.03<0.05,has statistical difference.So experimental group was better than that of the control group.4.Before the treatment,there was no statistical defference(P>0.05)between the two groups in the QOL score,indicating that the two groups were comparable in QOL score.The scores of QOL in the two groups before and after treatment were statistically different(P<0.05),indicating that the functional status of the two groups was improved.However,there were statistical differences(P<0.05)between the two groups after treatment,indicating that the experimental group was improving the functional status of the patients was better than that of the control group.Conclusions:1.Jiawei Shentong Zhuyu soup combined with pricking blood cupping treatment for breast cancer,postoperative upper limb swelling,can more effectively reduce edema,can obviously relieve the pain of the extremities,and which is more efficient.2.Jiawei Shentong Zhuyu soup,combined with blood letting puncture and cupping therapy can improve the postoperative breast cancer patients with upper limb swelling of the quality of life.更多还原