扶正调气利水法干预乳腺癌术后患者上肢水肿的前瞻性队列研究  

Prospective Cohort Study on the Treatment of Upper Limb Lymphedema after Breast Cancer Surgery by Reinforcing Healthy Qi,Regulating Qi and Draining Water

作　　者：郑红刚[1] 周雍明[1] 李丛煌[1] 张葛[1] 花宝金[1] ZHENG Honggang;ZHOU Yongming;LI Conghuang;ZHANG Ge;HUA Baojin(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《世界中医药》2022年第11期1506-1510,共5页World Chinese Medicine

基　　金：国家自然科学基金面上项目(82174463);中国中医科学院科技创新工程项目(CI2021A01804);中国中医科学院科技创新工程创新团队项目(CI2021B009)。

摘　　要：目的:通过观察协定处方“消肿通络方”内服外敷治疗乳腺癌术后患者并发上肢肿胀的临床疗效,探讨扶正调气利水法在乳腺癌术后并发症中的治疗作用,为中医肿瘤康复提供临床依据。方法:本研究采用前瞻性队列研究,以接受中医药治疗为暴露因素,选取乳腺癌术后上肢水肿的患者92例,分为观察组(n=48)和对照组(n=44),观察组在物理治疗同时结合中药“消肿通络方”内服外敷,对照组只采用物理治疗,观察患侧上臂周径变化、患者临床症状及生命质量的变化。结果:以扶正调气利水法为指导的中药“消肿通络方”内服外敷加用物理疗法在改善患者上肢水肿方面优于单纯理疗组(89.6%对比70.5%);治疗后各临床症状积分均较治疗前显著下降,差异有统计学意义(P<0.05或<0.01),与对照组同期比较差异有统计学意义(P<0.05);卡氏评分明显高于对照组。结论:扶正调气利水法联合物理疗法可改善乳腺癌术后上肢水肿,可改善疲劳、恶心呕吐、疼痛、睡眠障碍、食欲不振、大便异常等临床症状,提高患者生命质量,体现出“身心同调、内外兼治”的特点。Objective:To explore the effect of reinforcing healthy qi,regulating qi and draining water in the postoperative complications of breast cancer by internal and external application of Xiaozhong Tongluo Prescription to the treatment of upper limb lymphedema after breast cancer surgery,so as to provide clinical evidence for tumor rehabilitation in traditional Chinese medicine(TCM).Methods:A prospective cohort study was conducted on 92 patients with upper limb lymphedema after breast cancer surgery.They were divided into a treatment group and a control group according to the use of TCM treatment.The treatment group received physical therapy combined with the Xiaozhong Tongluo Prescription for internal and external application,while the control group received physical therapy alone.Changes in the circumference of the affected upper arm,the clinical symptoms of the patients and their quality of life were observed.Results:Xiaozhong Tongluo Prescription guided by reinforcing healthy qi,regulating qi and draining water and taken internally and externally combined with physical therapy,was better than the physical therapy alone in improving upper limb lymphedema(89.6%vs 70.5%).The scores of the clinical symptoms after treatment were decreased compared with those before treatment(P<0.05 or P<0.01),and compared with the conditions in the control group at the same period,the difference was statistically significant(P<0.05).The Karnofsky score(KPS)in the treatment group was significantly higher than that in the control group.Conclusion:The physical therapy combined with reinforcing healthy qi,regulating qi and draining water could relieve the upper limb lymphedema after breast cancer,alleviate clinical symptoms such as fatigue,nausea,vomiting,pain,sleep disorders,loss of appetite and abnormal stool,and improve the quality of life of the patients,embodying the characteristics of coherence of body and mind and simultaneous treatment of internal and external symptoms.

关 键 词：扶正调气 消肿通络方 乳腺癌 上肢水肿 淋巴水肿 循环减压 肿瘤康复 生命质量 

分 类 号：R273[医药卫生—中西医结合]