柴胡龙牡汤加减改善气机阻滞型肺癌系统综述

[主要目的]分析运用柴胡龙骨牡蛎汤加减改善气机阻滞型肺癌症状的临床资料。[资料来源]在辽宁中医药大学附属第一医院病案室,选取2011年9月至2012年9月辽宁中医药大学附属第一医院肿瘤科气机阻滞型肺癌住院患者病历。[选择文献量及依据]①研究类型:临床观察。②研究对象:病理诊断为肺癌,或未经病理诊断,但经过临床,影像学或实验室检查确诊为肺癌;辨证分型为气机阻滞型;均采用柴胡龙骨牡蛎汤加减治疗;中药连续使用≥2周;同一患者反复入院症状发生变化时重复纳入,无明显变化时仅纳入第一次入院情况。③评价指标:KPS评分,症候评分。共35例住院气机阻滞型肺癌患者原始病历。[数据提炼规则及应用方法]临床症状(咳嗽、咳痰、咳血、胸痛、胸闷、气急、乏力、便秘、恶心呕吐);临证加减(柴胡、龙骨、牡蛎、黄芩、太子参、半枝莲、白花蛇舌草、炙甘草、半夏、桔梗、杏仁、陈皮、浙贝母、莪术、胆南星、瓜蒌、山慈菇、夏枯草、黄芪)。采用Microsoft Exce 2013软件建立数据库,以证候出现、临证加减频次排列。生活质量评分参照卡氏评分,症状评分参照肺癌症状分级量化表,以咳嗽、咳痰等症状、体征为观察评价指标,依其程度分为轻、中、重三级,依次定为1、2、3分,根据症候改善积分判定疗效。[数据综合得出结果与结论]气机阻滞型肺癌症状出现频率依次为咳嗽、胸痛、咳痰、胸闷、气急、乏力、咳血、便秘、恶心呕吐。临证加减依次为使用柴胡、龙骨、牡蛎、黄芩30次,太子参、半枝莲、白花蛇舌草27次,炙甘草、半夏、茯苓24次,炙甘草、半夏、茯苓24次,桔梗、杏仁、陈皮20次,浙贝母17次,莪术14次,胆南星、瓜蒌13次,山慈菇11次,夏枯草10次,黄芪9次。KPS改善率31.00%。证候积分变化总有效率82.80%。用药规律,在柴胡龙骨牡蛎汤基础上,随证添加具有清热解毒软坚散结的抗肿瘤药物、化痰止咳平喘入肺经的药物、以及扶正益气药物。[未来展望]遵循循证医学原则及方法,进行更客观、可靠的大规模、多中心随机平行对照研究,更加有效指导临床实践。

Chaihu Longmu Soup To Improve Qi Activity Block Type System Evaluation In Patients With Lung Cancer

[Objective]To analysis using chaihulongmu soup improve Qi activity block type lung cancer clinical symptoms of patients with clinical data.[Source]Between September 2011 and September 2011 in the first affiliated hospital of liaoning university of TCM oncology Qi activity block type of lung cancer patients in hospital.[Select reference and basis]Types:(1) retrospective analysis.(2) the object of study: Selected cases after confirmed diagnosis for lung cancer cases,or without pathological diagnosis,but after clinical symptoms,imaging and laboratory tests in patients diagnosed with lung cancer;Syndrome differentiation type for Qi activity block type;Chinese medicine for use in 2 weeks or more than 2 weeks;Repeated the same patients admitted to hospital symptom changes repeatedly,and incorporated into without obvious changes into the hospital for the first time only.(3) evaluation indexes: the KPS score,the symptoms score.Total 35 cases in the hospital Qi activity block type the original medical records of patients with lung cancer.[Data extraction rules and application method]Clinical symptom,cough,expectoration,hemoptysis,chest pain,chest tightness and short of breath,fatigue,constipation,nausea and vomiting);Card to add and subtract in the situation(chaihu,longgu,muli,huangqin,taizishen,banzhilian,baihuasheshecao,zhigancao,banxia,jiegeng,etc).Microsoft excel 2013 software is adopted to establish the database for statistical analysis,appear with syndrome,clinical and subtract the frequency alignment.Cartesian score,quality of life score reference classification quantization table symptom scores refer to lung cancer symptoms,symptoms such as cough,sputum,signs as observation index,according to its degree is divided into light,medium and heavy level 3,and,in turn,as 1,2,3 points,according to the before and after treatment symptoms improve integral situation determined curative effect value.[Data comprehensive results and conclusions]Qi activity block type lung cancer clinical symptoms with coughing,chest pain,coughing up phlegm,chest distress,short of breath,fatigue,coughing up blood,constipation,nausea and vomiting syndrome frequency sequence alignment.Card to add and subtract in the use of chaihu,longgu,muli,huangqin 30 times,taizshen,banzhilian,baihuasheshecao 27 times,zhigancao,banxia,fuling 24 times,jiegeng,xingren,chenpi20 times,zhebeimu17 times,ezhu 14 times,dananxing,gualou 13 times,shancigu 11 times,xiakucao 10 times,huangqi 9 times,with clinical and subtract frequency lined.KPS period was 31.00%.Syndrome integral change total effective rate was 82.80%.Use of chaihulongmu soup for liver and qi stagnation type lung cancer,clinical drug laws,add and subtract gradually formed on the basis of chaihulongmu soup,with the added has qingrejiedu soft firm fights antitumor drugs,eliminating phlegm,cough and asthma drugs into the lung,and righting yiqi pills.[Future]In future study,should follow the principles and methods of evidence-based medicine,on a large scale,multicenter randomized controlled trial study,make the results more objective,reliable,and to guide clinical practice more effectively.