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  本文關(guān)鍵詞：養(yǎng)陰清肺涼血方治療放射性肺炎臨床療效觀(guān)察　出處：《河北大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 放射性肺炎 中藥 中西醫(yī)結(jié)合療法 養(yǎng)陰清肺涼血方 臨床觀(guān)察

【摘要】：目的:放射性治療(下文簡(jiǎn)稱(chēng)放療)是被廣泛運(yùn)用于肺癌、乳腺癌、食管癌、縱隔腫瘤、胸腺腫瘤等胸部腫瘤治療中。在胸部各器官組織中,肺對(duì)輻射相對(duì)敏感,在超過(guò)肺部生物效應(yīng)閾值的放射線(xiàn)劑量照射后,腫瘤周?chē)�的肺組織會(huì)產(chǎn)生程度輕重不一的受損,同時(shí),在放射野內(nèi)的正常肺組織受到放射后也會(huì)產(chǎn)生損傷導(dǎo)致炎癥反應(yīng),這種炎癥反應(yīng)被稱(chēng)為放射性肺損傷(RILI)。由于在放療過(guò)程中,正常肺組織也一同受到照射,不可避免地會(huì)受到損傷,放射劑量隨之受到限制,最終會(huì)致使腫瘤局部治療效果的降低甚至是放療方案的中斷,嚴(yán)重困擾放療過(guò)程。其發(fā)生率達(dá)5%—15%。放射學(xué)改變的發(fā)生率則高達(dá)15%—100%。放射性肺損傷早期表現(xiàn)為放射性肺炎(RP),屬于急性期反應(yīng),肺實(shí)質(zhì)受損程度較輕,早期介入,通過(guò)系統(tǒng)治療尚可逆轉(zhuǎn);放射性肺炎若無(wú)有效控制,肺實(shí)質(zhì)嚴(yán)重受損,往往會(huì)不可逆發(fā)展為肺纖維化,發(fā)展到晚期即放射性肺纖維化(RPF)。一旦發(fā)生放射性肺損傷,將嚴(yán)重影響患者的治療效果、生活質(zhì)量及預(yù)后,甚則直接導(dǎo)致死亡。因此,盡早治療放射性肺炎、控制并發(fā)癥具有極大的臨床價(jià)值。方法:兩組分別給予在(1)肺炎Ⅰ、Ⅱ級(jí):注射用甲潑尼龍0.5-1mg/kg/d,靜脈滴入,依據(jù)病情調(diào)整劑量,癥狀好轉(zhuǎn)逐步降低劑量,持續(xù)2-6周,同時(shí)給予預(yù)防性使用抗生素。(2)肺炎Ⅲ級(jí):注射用甲潑尼龍1-1.5mg/kg/d,靜脈滴入,依據(jù)病情調(diào)整劑量,癥狀好轉(zhuǎn)逐步降低劑量,持續(xù)2-6周,同時(shí)給予預(yù)防性使用抗生素。治療組以上方案為基礎(chǔ),加用養(yǎng)陰清肺涼血方口服治療,其方劑組成如下:黃芩20g,丹皮15g,丹參20g,赤芍20g,天冬20g,玄參20g,五味子12g,竹茹10g,桑白皮15g,天花粉15g,杏仁10g。水煎服,日1劑,分早晚2次溫服,4周為一療程,連續(xù)使用3個(gè)療程,共計(jì)12周。分別在治療4周,8周,12周時(shí)觀(guān)察患者咳嗽,氣短,乏力等中醫(yī)癥狀變化,以此建立評(píng)分表,評(píng)分項(xiàng)目包括患者呼吸困難程度、肺功能及身體機(jī)能狀態(tài),通過(guò)兩組患者的評(píng)分差異,分析治療放射性肺炎的綜合療效和患者身體狀況變化,并初步探索養(yǎng)陰清肺涼血方聯(lián)合抗生素、激素中西醫(yī)結(jié)合治療放射性肺炎的臨床療效。結(jié)果:本實(shí)驗(yàn)含治療組(中西醫(yī)結(jié)合方案)30例,對(duì)照組(單純西醫(yī)方案)30例,共計(jì)60例患者。對(duì)比發(fā)現(xiàn),治療組總有效率90%,高于對(duì)照組總有效率73.3%,P0.05,結(jié)果具有統(tǒng)計(jì)學(xué)意義,結(jié)論:治療組療效明顯優(yōu)于對(duì)照組。結(jié)論:通過(guò)對(duì)比觀(guān)察實(shí)驗(yàn),養(yǎng)陰清肺涼血方聯(lián)合抗生素、激素中西醫(yī)結(jié)合治療放射性肺炎,療效顯著優(yōu)于單純西醫(yī)治療,在中醫(yī)學(xué)整體觀(guān)點(diǎn)、辨證論治思想指導(dǎo)下,通過(guò)四診合參,具體分析患者病情階段、臨床表現(xiàn)、基礎(chǔ)疾病等,顯示中藥養(yǎng)陰清肺涼血方臨床治療放射性肺炎的臨床療效確切,可有效緩解和改善患者胸悶、氣短、咳嗽、咯痰等臨床癥狀,降低毒副作用,提高總體療效,改善患者生活質(zhì)量,維持身心健康。養(yǎng)陰清肺涼血方建立在多年臨床經(jīng)驗(yàn)總結(jié)的基礎(chǔ)上,組方科學(xué)合理,療效確切可靠,明顯改善臨床癥狀,緩解患者疼痛,是治療放射性肺炎的安全可靠用藥。
[Abstract]:Purpose: radiation therapy (hereinafter referred to as radiotherapy) is widely used in lung cancer, breast cancer, esophageal cancer, mediastinal tumor, thymus tumor and other chest cancer treatment. In various organs in the chest and lung are relatively sensitive to radiation in the radiation biological effect threshold dose over the lungs after irradiation damage around the tumor the lung tissue will produce a degree at the same time, by radiation in the radiation field in the normal lung tissue will produce inflammation, the inflammation is called radioactive lung injury (RILI). The radiotherapy process, normal lung tissue were affected by irradiation, will inevitably damage, radiation the dose will be restricted, reduce will eventually cause local tumor treatment and even interrupt radiotherapy, serious problems of radiotherapy process. The incidence of up to 5% 15%. X-ray change is as high as 15 % - 100%. of radiation-induced lung injury in early stage of radiation pneumonitis (RP), which belongs to the acute phase response of lung parenchyma damaged to a lesser extent, early intervention, the treatment system is reversible; if there is no effective control of radioactive pneumonia, lung parenchyma severely damaged, often irreversible for the development of pulmonary fibrosis, to the development of advanced radioactive pulmonary fibrosis (RPF). Once the occurrence of radiation-induced lung injury, will seriously affect the patient's treatment effect, life quality and prognosis, even a direct cause of death. Therefore, the treatment of Radioactive Pneumonia as soon as possible, is of great clinical value in the control of complications. Methods: two groups were given in (1) pneumonia I, II: 0.5-1mg/kg/d injection of methylprednisolone, intravenous infusion, dose adjustment according to the illness, the symptoms gradually reduce the dose for 2-6 weeks, while giving prophylactic antibiotics. (2): 1-1.5mg/kg/d pneumonia III methylprednisolone intravenous injection. Infusion dose adjustment according to the illness, symptoms gradually reduce the dose for 2-6 weeks, while giving prophylactic use of antibiotics. The treatment group above as a basis, combined with Yangyin Qingfei Liangxue Decoction oral treatment, the prescription is as follows: 20g of Radix Scutellariae, paeonol 15g, 20g Salvia miltiorrhiza, Radix Paeoniae Rubra 20g, aspartate 20g, Scrophularia 20g. Schisandra 12g, 10g Zhuru, 15g Sangbaipi, trichosanthin 15g, almond 10g. water decoction, daily 1 agent, and the 2 day, 4 weeks for a course of treatment, continuous use of 3 courses, a total of 12 weeks. In the treatment of 4 weeks, 8 weeks, 12 weeks were observed in patients with cough, shortness of breath, change fatigue and other symptoms of traditional Chinese medicine, in order to establish the scale, scores include dyspnea, pulmonary function and body function condition, the score between the two groups of patients, analysis of changes in the treatment of radiation pneumonia curative effect and physical condition of patients, and to explore the Yangyinqingfei Liangxue decoction combined with anti Antibiotics, clinical curative effect of the treatment of radiation pneumonitis with hormone and Western medicine. Results: the treatment group (including the scheme of combining traditional Chinese and Western medicine in 30 cases), control group (Western medicine regimen) in 30 cases, a total of 60 patients. By comparison, the total effective rate of treatment group 90% was higher than the control group, the total efficiency of 73.3%, P0.05 and the results have statistical significance, conclusion: the curative effect of treatment group was significantly better than the control group. Conclusion: through the contrast experiment, Yangyin Qingfei Liangxue decoction combined with antibiotics, the treatment of Radioactive Pneumonia Combined with hormone of TCM and Western medicine, the curative effect was significantly better than the pure western medicine treatment, traditional Chinese medicine in the overall view of syndrome differentiation theory, through the combination of all the specific. Analysis of the disease stage, clinical manifestations, basic diseases, show the clinical curative effect of traditional Chinese medicine Yin Qingfei Liangxue Decoction clinical treatment of radiation pneumonitis is effective, alleviate and improve the patients with chest tightness, shortness of breath, cough, expectoration, effective, etc. The clinical symptoms, reduce side effects and improve the overall curative effect, improve the life quality of patients, to maintain physical and mental health. Yangyinqingfei Liangxue Decoction based on years of clinical experience, the prescription is scientific and reasonable, reliable curative effect, improve clinical symptoms, relieve the pain of patients, is a safe and reliable treatment of radiation pneumonitis.

【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R730.55

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