中医药对乳腺癌围手术期应激反应的影响  

Effects of Chinese Medicine on Stress Reaction at Perioperative Stage of Breast Cancer

作　　者：秦悦农[1] 鲍以嘉[1] 

机构地区：[1]上海龙华医院,上海200032

出　　处：《河南中医》2015年第3期466-468,共3页Henan Traditional Chinese Medicine

基　　金：上海市卫生局科研课题计划项目(编号:20124060)

摘　　要：中医认为,手术创伤对机体整体的内环境均存在破坏作用,主要表现在气血方面的干扰和损伤以及脏腑功能的失调。围手术期应激反应与脏腑的关系表现于心、肝、肾的生理特点和功能。其中,心为神之居、血之主、脉之宗。心在五行属火,其生理功能以主血脉、主神志为主,术前的精神紧张,或由此而产生的焦虑抑郁以及恐惧情绪可使心气大乱、血脉瘀滞,同时术中手术创伤耗血伤气,可应激性地影响心对血脉运行的调控作用,使血液运行失常。而肝为魂之处,血之藏,筋之宗。肝在五行属木,主升主动,生理功能以主疏泄、主藏血为主。术中大量失血使肝体失养,可致肝之疏泄功能失常。中医理论认为肝之疏泄功能表现在血液精微输布以及精神、情绪调节两个方面,因此其疏泄功能受损可直接影响血液输布以及其他脏腑器官的濡养,同时也可造成患者在围手术期出现不良情绪。另一方面,患者的焦虑抑郁或恐惧情绪等作为心理应激的重要组成部分,若不能得到及时有效的疏解和发泄,也可反作用于肝脏功能,导致肝气郁结,疏泄失调。肾作为先天之本,其气血盛衰决定着患者体质,也影响着患者对于围手术期相关应激的耐受能力以及防御、抵抗能力。因此心、肝、肾在围手术期中对应激反应有着重要的影响作用。针对乳腺癌而言,联合应用益气养阴和疏肝解郁的中药应可取得生理心理两方面的获益。TCM holds that operative wound would bring damage to the internal environment of human body,which mainly manifests as the disturbance of qi and blood and the disorder of visceral function.The relationship between the perioperative stress reaction and the viscera lies in the physiological feature and function of the heart,liver and kidney.Among them,heart is the house of spirit,dominates blood and governs the pulse.Heart belongs to fire in five elements,whose main physiological function is dominating blood vessel and spirit.Mental stress before operation or the induced anxiety,depression and fear may disturb the heart qi and cause stagnant blood vessel.During the operation,blood and qi are impaired,which influences the heart＇s regulation of blood vessels and leads to disorder of blood flow.Liver is the house of ethereal-soul,stores blood and governs tendon.Liver belongs to wood in five elements and dominates ascending and moving,whose main physiological feature is governing free coursing.Massive blood loss during operation may cause malnourishment of the liver and thus its dysfunction of governing free coursing.According to TCM theory,liver＇s function of governing free coursing mainly manifests in two aspects： distribution of blood and essence,regulation of spirit and mental state.The impairment of this function will directly influence the the distribution of blood and the nourishment of other viscera; simultaneously,bad mood may thus induced at the perioperative stage.Besides,the failure of patients＇ anxiety,depression or fear as an important part of mental stress to get timely relief will counteract the liver function and cause liver qi depression and disordered free coursing.Kidney is the congenital root,whose waxing and waning of qi and blood determines the patient＇s constitution and also influence the tolerance,defense and resistivity to relative perioperative stress reaction.Therefore,the heart,liver and kidney have great influence on perioperative stress reaction.For breast cancer,Chinese drugs wh

关 键 词：乳腺癌 围手术期 应激反应 益气养阴 疏肝解郁 

分 类 号：R273.737.9[医药卫生—中西医结合]