殷东风教授运用柴胡加龙骨牡蛎汤加减治疗乳腺癌术后患者经验总结

【作者】 崔小天；

【导师】 殷东风；

【作者基本信息】 辽宁中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 目的:通过观察殷东风教授运用饮片治疗77例乳腺癌术后患者,总结其运用柴胡加龙骨牡蛎汤加减治疗乳腺癌术后的经验。方法:将77例2008年12月-2010年7月之间就诊于辽宁中医药大学附属医院肿瘤科门诊的乳腺癌术后患者,对患者的背景因子﹑常见症状﹑症状改善率﹑PS评分及平均症状改善率与PS评分之间的关系进行分析。运用配对T检验比较治疗前后各症状的评分,运用卡方检验比较治疗前后各PS评分人数间的构成比,运用相关分析分析PS评分人数与平均症状改善率的相关性。结果:1、77例女性乳腺癌术后患者平均50.3岁;激素受体阴性患者17例,其余60例患者为口服内分泌治疗的激素受体阳性患者;术后出现骨、软组织,或无症状内脏转移患者为16例;患者PS评分除1例在3分以外,其余患者均在0-2分,其中0分为22例,1分为39例,2分为15例。2、主要症状有15种,出现频率由高到低排列依次为为睡眠欠佳(72.70%)、乏力(70.10%)、自汗盗汗(55.80%)、口干口苦(41.60%)、疼痛(39%)、哄热(36.40%)、术肢浮肿(22.10%)、胸闷气短(18.20%)、便溏(18.20%)、烦躁(18.20%)、胸胁胀痛(18.20%)、饮食欠佳(15.60%)、手足心热(14.30%)、便秘(13%)、畏寒(10.40%)。2、口服柴胡加龙骨牡蛎汤加减饮片对于15种症状的均有改善作用,尤其对饮食不振(症状改善率为83.33%)、自汗盗汗(79.07%)、胸胁胀痛(78.57%)、乏力(66.6%)、等躯体症状和烦躁(85.71%)、睡眠欠佳(64.28%)等心身症状的疗效显著。15个症状治疗后与治疗前的评分比较均有显著差别(p<0.01)。3、治疗后在PS评分方面,PS评分改善者共33人,稳定者共44人,无患者进展,PS改善率42.9%。PS为0-1分患者由61人增加至75人, 2-3分患者由16人减少至2人,经卡方检验治疗前后PS为0-1分和2-3分人数的构成比有明显的差别(p<0.05)。4、患者经柴胡加龙骨牡蛎汤加减治疗后,PS评分为0分,1分,2分的患者平均症状改善率分别为67.78%,52.88%,45.69%,两者呈负性相关(r>1,p<0.05)。结论:1、术后乳腺癌患者即指手术及放化疗之后,应用或未应用内分泌治疗药物,包括骨、软组织及无症状内脏转移的患者。殷东风教授认为治疗术后乳腺癌更注重条畅气机,提出调畅气机亦是扶正的观点。2、柴胡加龙骨牡蛎汤加减治疗不但可以改善术后乳腺癌患者不适症状而且可以改善并维护患者的生存质量。3、PS评分在0-2分期间的术后乳腺癌患者,以柴胡加龙骨牡蛎汤加减调畅气机以扶正抗癌。而对于PS评分在3-4分的乳腺癌术后患者,殷师认为多以身体各脏腑机能虚损为主,治疗上应多以补益气血,平衡阴阳为主,调畅气机为辅。更多还原

【Abstract】 Objective:Professor Yin Dong-feng to the out-patient case study data, summarize the use of Chaihujialonggumuli decoction for treatment of postoperative breast cancer experience.Methods:selected a tatle of 77 patients with breast cancer patients , who being treated in the University Hospital of Liaoning TCM oncology outpatient clinic between December 2008 to 2010 july 2010, to Analysis the background factors of patients、common symptoms、Symptom improvement rate , PS score and The relationship between average rate of symptom improvement and PS score. Compared using paired T test scores before and after treatment of the symptoms, the use of chi-square test to compare scores before and after treatment the number of PS between the constituent ratio, the use of correlation analysis of the number of PS and the average symptom score improvement rate correlation.Results:1.77 cases patients were female, aged 22 to 72 years, median age 45 years. PS scores were only 1 case in 3, the rest of the patients were in the 0-2, where 0 is divided into 22 cases, 39 cases were divided into 1, 2 divided into 15 cases. Patients with postoperative radiotherapy and chemotherapy were 33 cases and 52 cases. 17 cases of hormone receptor-negative patients, the remaining 60 patients were hormone receptor-positive patients. Among them 16 cases (20.1%) of recurrence after surgery, transfer patients.2 .The main symptoms of 15 species, the first five high frequency of symptoms of poor sleep, fatigue, spontaneous sweating, dry mouth, mouth pain, and pain.3.Oral Chaihujialonggumuli decoction of 15 Pieces for the role of the symptoms were improved, especially for food appetite (symptom improvement rate was 83.33%), spontaneous sweating (79.07%), Xiong Xie pain (78.57%) , Fatigue (66.6%), and other physical symptoms and irritability (85.71%), poor sleep (64.28%), and other psychosomatic symptoms in a significant effect. 15 symptoms after treatment compared with pre-treatment scores were significantly improved (p <0.01).4.Score after treatment in terms of PS, PS total score improved in 33 (42.9%), stable by a total of 44 (57.1%), PS to improve the rate of 42.9%.5.Patients after Chaihujialonggumuli decoction treatment, PS score of 0 points, 1 point, 2 points with an average symptom improvement rate was 67.78%, 52.88%, 45.69%, negative correlation between (r > 1, p <0.05).Conclusion:1. Postoperative breast cancer Refers breast cancer patients after surgery and radiotherapy and chemotherapy, endocrine therapy Whether or not, including bone, soft tissue and visceral metastasis in asymptomatic patients.Professor Yin Dongfeng pay more attention to the treatment of postoperative breast cancer section of Qi is proposed adjusting qi is righting the point of view.2.During the PS score of 0-2 to Chaihujialonggumuli decoction to adjusting qi. As for the PS score 3-4 points in breast cancer patients, Yin opinion to the body organs function more than wasting the main treatment should be more use of replenishing qi and blood, yin and yang balance of the main adjusting qi supplemented .3.Chaihujialonggumuli decoction for treatment of not only breast cancer patients after surgery can improve symptoms but also improve and maintain the quality of life of patients.更多还原