恶性肿瘤合并下肢深静脉血栓形成证治规律系统综述

Malignant Tumor of Deep Venous Thrombosis Syndrome and Law Systematic Review

[主要目的]分析恶性肿瘤合并下肢深静脉血栓形成证治规律临床资料。[资料来源]在辽宁中医药大学附属第一医院病案室,选取2008年1月至2012年11月辽宁中医药大学附属第一医院肿瘤科合并LDVT恶性肿瘤患者病历。[选择文献量及依据]①研究类型:临床观察。②研究对象:病理诊断为恶性肿瘤,或未经病理诊断,但经临床症状,影像学或者实验室检查确诊为恶性肿瘤;经彩色多普勒超声检查,确诊为下肢深静脉血栓形成;在院期间均采用中药汤剂口服进行治疗;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诊断分型:气滞血瘀型:患肢肿胀,皮温略高,局部皮肤暗紫,情志抑郁,善太息,时有胸胁胀闷,纳差,嗳气,小便不利,腹胀便溏,舌淡,苔薄,脉细涩。脾虚湿困型:患肢浮肿,活动后加重,神疲乏力,皮色略暗,时有腹部隐痛,纳差,小便不利,舌淡,可边有齿痕,苔薄白,脉沉。④评价指标:ZPS评分、有效率、死亡率。共23例住院合并LDVT恶性肿瘤患者原始病历。[数据提炼规则及应用方法]采用描述性统计分析方法,对合并LDVT恶性肿瘤患者临床表现、治疗情况进行统计,并对出现下肢深静脉血栓时的功能状态(Performance Status)进行评分。疗效判定:参照下肢深静脉血栓治疗效果判定标准。功能状态:采用Zubrud-ECOG-WHO(ZPS,5分法)。采用SPSS19.0统计软件,对患者治疗后的有效率和死亡率进行统计学分析,利用Fisher确切概率法(Fisher’s exact test)对其与中医证型及ZPS评分的关系进行分析。采用Microsoft Excel 2013软件建立数据库,进行临床症状频率计算,以症状出现频次排列。[数据综合得出结果与结论]主要临床症状及体征以重度浮肿、面色少华、乏力、纳差、舌淡、情志抑郁、腹部隐痛、善太息等出现频次依次排列。根据合并LDVT的恶性肿瘤患者主要临床症状和体征,23例患者经辨证分为气滞血瘀证12例和脾虚湿困证11例。气滞血瘀证症状改善优于脾虚湿困证(P<0.05)。中医证型与死亡率没有明显相关性(P=0.069>0.05),ZPS<3分死亡率较ZPS≥3分低(P=0.017<0.05)。从临床症状、体征、恶性肿瘤的转移及ZPS评分情况来分析,脾虚湿困证患者的症状重于气滞血瘀证患者,转移率较后者高,患者的功能状态也劣于后者,故其临床治疗的缓解率低,且不论死亡率较后者高。[未来展望]中医药对恶性肿瘤合并下肢深静脉血栓形成治疗作用显著,尤其对实证为主的气滞血瘀证疗效更为明显,值得临床推广,但其分型和治疗的规范化仍是目前亟须解决的问题。

[Objective]Analysis of malignant tumor of deep venous thrombosis syndrome and law clinical data.[Source] Liaoning University of Traditional Chinese Medicine First Affiliated Hospital medical record room,select the First Affiliated Hospital of Liaoning University of Traditional Chinese Medicine Oncology merger of LDVT cancer patient records from January 2008 to November 2012.[Select literature and Basis]①The type of research： A retrospective study of clinical data.②Subjects： Pathological diagnosis of malignancy,with or without pathological diagnosis,clinical symptoms,imaging or laboratory diagnosis of malignancy;by color Doppler ultrasound diagnosis of deep venous thrombosis;during the hospitalare made of traditional Chinese medicine decoction oral treatment;repeated incorporated into the same patients repeatedly hospitalized symptoms of change,no significant changes in the inclusion of only first admissions.③Diagnostic classification： Qi and blood stasis： limb swelling,skin temperature slightly higher local skin dark purple,emotional depression,deep sigh,chest swelling,nausea,loss of appetite,belching,dysuria,abdominal distension,loose stoolsas the main performance,pale tongue,thin fur,thready pulse astringent.Spleen insufficiency： limb edema,increased after the event,lassitude,slightly darker skin color,abdominal pain,anorexia,urination,pale tongue,with scalloped edges,thin white fur,pulse as the main clinical manifestations.④Evaluation index： ZPS score for efficiency,mortality and other indicators.Total of 23 patients with combined LDVT original medical records of patients with malignant tumors.[Data refinement rules and Application methods]Using descriptive statistical analysis method,the clinical manifestations of on combined LDVT the patients with malignant tumors,treatment statistics,and functional status in patients with deep venous thrombosis（Performance Status） rating.Efficacy determination： Refer to the therapeutic effect of deep vein thrombosis criteria.Functional status： Zubrud to-ECOG-WHO（ZPS,5-point）.Select SPSS19.0 statistical software,efficiency and mortality after treatment were statistically analyzed using Fisher＇s exact test（Fisher＇s Exact test） to analyze its relationship between TCM and ZPS score.To establish a database using Microsoft Excel 2013 software,the frequency of clinical symptoms,the arrangement of the frequency of symptoms.[Results and Conclusions from data integration]The main clinical symptoms and signs of severe edema,pale,fatigue,anorexia,pale tongue emotional depression,abdominal pain,good heave a deep sigh frequency sequence.23 patients,cancer patients according to the combined LDVT the main clinical signs and symptoms of the syndrome is divided into 12 cases of qi and blood stasis and Spleen insufficiency 11 cases.Qi and blood stasis symptom improvement superior to the spleen insufficiency certificate（P0.05）.TCM syndrome and mortality was not significantly correlated（P = 0.0690.05）,ZPS3 mortality than ZPS≥ 3（P = 0.0170.05）.From clinical symptoms,signs,metastasis of malignant tumors and ZPS score of analysis,spleen dampness syndrome symptoms and blood stasis syndrome,the transfer rate than the latter,the patient＇s functional status inferior to the latter,its clinical remission rate,and regardless of mortality than the latter.[Future Prospects]Chinese medicine in the treatment of malignant tumors with lower extremity deep vein thrombosis role significantly,especially for evidence based Qi and blood stasis,and its effect more obvious,worthy of promotion,but the classification and standardization treatment is still the urgent need to resolve the problem at present.