【摘要】：研究目的：以溫陽逐水膏外敷聯(lián)合常規(guī)放腹水后藥物灌注治療對惡性腹水進行療效觀察,并與單純常規(guī)放腹水后藥物灌注治療進行比較,觀察兩組治療后對惡性腹水的臨床療效、對患者生活質量的影響、并觀察對腫瘤標志物及血清VEGF變化,從而初步探討溫陽逐水膏外治方的作用機理,進而為中藥外治法治療惡性腹水提供客觀依據。研究方法：將60例惡性腹水患者,隨機分為兩組,每組30例,一組為治療組(以溫陽逐水膏外敷聯(lián)合常規(guī)放腹水后藥物灌注治療),另一組為對照組(單純放腹水后藥物灌注治療)。治療方法：對照組常規(guī)放腹水(腹腔穿刺后放腹水治療,首次放腹水不超過1000ml,以后通過微導管每次放腹水不超過2000ml),經放腹水治療,在腹水明顯減少的基礎上,以香菇多糖4mg、白介素-2300萬單位聯(lián)合腹腔灌注,每周2次,2周為一療程。治療組在上述治療和用藥基礎上,避開穿刺點處外敷溫陽逐水膏,按20mg/kg體重給藥,涂藥范圍為上至劍突下,下至臍下10cm,在腹壁上保留24小時,隔日一次,共2周為一療程。療程結束后進行兩組療效比較,觀察治療后兩組腹水的變化及生活質量方面的影響,并觀察對腫瘤標志物與血清VEGF的變化。研究結果：溫陽逐水膏組總有效率達80.0%,單純常規(guī)放腹水組總有效率為56.7%；腹水最大液平直徑溫陽逐水膏組減少4.23cm,單純放腹水組減少3.13cm,組間差異有統(tǒng)計學意義(p0.05)；治療后兩組病人均不同程度腹脹減輕,排氣增多,納食增加,小便量增多,生活質量得到改善,中醫(yī)癥候積分值經統(tǒng)計分析,治療組優(yōu)于對照組；經治療后兩組患者卡氏評分比較,差異顯著：治療組優(yōu)于對照組；治療后CA199、VEGF值較治療前降低,溫陽逐水膏組較單純常規(guī)放腹水組更明顯,差異有統(tǒng)計學意義；兩組對血液、肝腎功能及心臟功能均無明顯影響,且治療組還能一定程度糾正貧血及改善肝功能；對不良反應的發(fā)生情況分析治療組發(fā)生率低于對照組,從而表明治療組與對照組比較療效更突出,且安全性高,無明顯不良反應。研究結論：溫陽逐水膏外敷聯(lián)合常規(guī)放腹水后藥物灌注治療惡性腹水是有效的,在減輕臨床癥狀及體征、改善患者生活質量以及對腫瘤標志物、VEGF的影響方面優(yōu)勢更明顯；相對于對照組,未增加毒副作用。因此,在常規(guī)治療的基礎上聯(lián)合外敷溫陽逐水膏可作為臨床上治療治療惡性腹水的有效手段。溫陽逐水膏外敷治療惡性腹水,操作簡單方便,且安全可靠,療效確切,值得進一步推廣應用。
[Abstract]:Objective: to observe the therapeutic effect of Wenyang Zhushui ointment combined with routine post-ascites infusion therapy on malignant ascites and compare it with that of simple routine post-ascites infusion therapy. To observe the clinical effect and quality of life of patients with malignant ascites after treatment, and to observe the changes of tumor markers and serum VEGF, so as to explore the mechanism of Wenyang Zhushui ointment for external treatment. It provides objective basis for external treatment of malignant ascites with traditional Chinese medicine. Methods: sixty patients with malignant ascites were randomly divided into two groups, 30 patients in each group. One group was treated with Wenyang Zhushui ointment and the other was control group. Treatment method: the control group was treated with routine ascites (ascites were not more than 1000ml for the first time and 2000ml for each time by microcatheter). Lentinus edodes polysaccharides 4 mg, interleukin-23 million units combined intraperitoneal perfusion, twice a week, 2 weeks as a course of treatment. On the basis of the above treatment and medication, the treatment group was given according to the body weight of 20mg/kg by avoiding the application of Wenyang Shuishui ointment at the puncture point. The range of application was up to 10 cm under the xiphoid process and down to the subumbilical layer, and it was kept on the abdominal wall for 24 hours, once every other day, for a course of treatment for 2 weeks. The changes of ascites and quality of life in the two groups were observed after the treatment, and the changes of tumor markers and serum VEGF were observed. The results showed that the total effective rate of Wenyang Zhushui ointment group was 80.0, the total effective rate of simple routine ascites group was 56.7, the maximum fluid level of ascites was 4.23 cm, and that of simple ascites group was 3.13 cm, the difference between groups was statistically significant (p0.05). After treatment, the abdominal distension, exhaust, food intake, urine volume and quality of life were improved in both groups. The integral value of TCM symptom was better than that of the control group after statistical analysis. After treatment, there were significant differences between the two groups: the treatment group was superior to the control group, the CA199,VEGF value of the treatment group was lower than that of the pre-treatment group, and the difference between the two groups was more obvious than that of the simple routine ascites group, and the difference between the two groups was statistically significant. The incidence of adverse reactions in treatment group was lower than that in control group, and the incidence of adverse reactions in treatment group was lower than that in control group. The results showed that the treatment group was more effective than the control group, with high safety and no obvious adverse reactions. Conclusion: it is effective to treat malignant ascites with external application of Wenyang Zhushui ointment combined with routine ascites infusion. It has more advantages in relieving clinical symptoms and signs, improving patients' quality of life, and influencing tumor markers and VEGF. Compared with the control group, no side effects were increased. Therefore, combined application of Wenyang Zhushui ointment on the basis of routine treatment can be used as an effective method for the treatment of malignant ascites. The treatment of malignant ascites with Wenyang Zhushui ointment is simple and convenient, safe and reliable, and worthy of further application.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R730.5

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