参芪消结汤配合复方丹参片对乳腺癌改良根治术围术期细胞免疫功能、高凝状态、应激反应及临床预后的影响

Effect of Shenqi Xiaojie Decoction combined with Compound Danshen tablet on perioperative cellular immune function, hypercoagulable state, stress response and clinical prognosis of modified radical mastectomy for breast cancer

目的观察参芪消结汤配合复方丹参片对乳腺癌改良根治术患者围术期细胞免疫功能、高凝状态、应激反应及临床预后的影响。方法将95例拟择期行乳腺癌改良根治术的患者按照随机数字表分为观察组(48例)及对照组(47例),对照组术后给予常规治疗,观察组在对照组基础上给予参芪消结汤^+复方丹参片治疗,治疗至术后7d。记录2组术前及术后3d、5d、7d的细胞免疫功能(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)、凝血纤溶指标[活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(Plt)]、应激反应指标[血清C反应蛋白(CRP)、皮质醇(Cor)]的变化,并比较2组临床结局。结果2组术后3dCD3^+、CD4^+、CD4^+/CD8^+均明显低于术前(P均<0.05),术后5d明显高于术后3d(P均<0.05);观察组于术后7d基本恢复至术前水平(P均>0.05),而对照组仍低于术前(P均<0.05);观察组术后3~7d以上指标均明显高于对照组(P均<0.05);2组CD8^+变化趋势与以上指标呈相反趋势。2组术后3dAPTT、PT、TT均明显短于术前(P均<0.05),术后5d明显长于术后3d(P均<0.05);观察组于术后7d基本恢复至术前水平(P均>0.05),而对照组仍明显短于术前(P均<0.05);观察组术后3~7d以上指标均明显长于对照组(P均<0.05)。2组术后3dPlt、FIB、D-二聚体、CRP、Cor水平均明显高于术前(P均<0.05),术后5d明显低于术后3d(P均<0.05);观察组于术后7d基本恢复至术前水平(P均>0.05),而对照组仍明显高于术前(P均<0.05);观察组术后3~7d以上指标均明显低于对照组(P均<0.05)。观察组术后3~7d的疲乏视觉模拟评分(VAS)均显著低于对照组(P均<0.05)。观察组术后并发症总发生率显著低于对照组(P<0.05),术后引流管留置时间、创面愈合时间、术后住院时间均显著短于对照组(P均<0.05)。结论参芪消结汤配合复方丹参片可显著促进乳腺癌改良根治术后患者细胞免疫功能恢复,抑制高凝状态及应激反应,减轻术后疲乏,从而减少术后并发症,缩短创面愈合时间及住院时间。

Objective It is to observe the effects of Shenqi Xiaojie Decoction combined with Compound Danshen tablet on perioperative cellular immune function,hypercoagulability,stress response and clinical prognosis in patients with breast cancer undergoing modified radical mastectomy.Methods Ninety-five patients with breast cancer undergoing modified radical mastectomy were divided into observation group(48 cases)and control group(47 cases)according to the random number table.The control group was given routine treatment after operation,and the observation group was given Shenqi Xiaojie Decoction+compound Danshen tablets on the basis of the control group.All the patients were treated until 7 days after surgery.The changes of cellular immune function(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)and coagulation and fibrinolysis index[activated partial thrombin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),D-dimer(DD),platelet count(Plt)],stress response indicators[serum C-reactive protein(CRP),cortisol(Cor)]were recorded before and 3 d,5 d and 7 d after operation in the two groups,and the clinical outcomes were compared.Results The levels of CD3^+,CD4^+,CD4^+/CD8^+in 3 days after operation in the two groups were significantly lower than those before operation(P<0.05),and the indexes in 5 days after operation were significantly higher than those in 3 days after operation(P<0.05).The indexes in the observation group recovered to the levels before operation,while the control group was still lower than the preoperative(P<0.05).The indexes of the observation group in 3-7 days after operation were significantly higher than the control group(P<0.05).The trend of CD8^+in the two groups had the opposite trend of the above indexes.The APT,PT and TT in 3 days after operation in the two groups were significantly shorter than those before operation(P<0.05),and the indexes in 5 days after operation were significantly longer than those in 3 days after operation(P<0.05).The indexes in the observation group recovered to the levels before operation,while the control group was still shorter than the preoperative(P<0.05).The indexes of the observation group in 3-7 days after operation were significantly longer than the control group(P<0.05).The levels of Plt,FIB,D-dimer,CRP and Cor in 3 days after operation in the two groups were significantly higher than those before operation(P<0.05),and were significantly lower in 5 days after operation than those in 3 days after operation(P<0.05).The indexes in the observation group recovered to the levels before operation,while the control group was still higher than the preoperative(P<0.05).The indexes of the observation group in 3-7 days after operation were significantly lower than the control group(P<0.05).The scores of fatigue visual analogue scale(VAS)of the observation group were significantly lower than that of the control group at 3 to 7 days after operation(P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).The drainage tube indwelling time,wound healing time and postoperative hospital stay were significantly shorter than the control group(P<0.05).Conclusion Shenqi Xiaojie Decoction combined with Compound Danshen Tablet can significantly promote the recovery of cellular immune function after modified radical mastectomy,inhibit hypercoagulable state and stress response,reduce postoperative fatigue,reduce postoperative complications and shorten wound healing time and hospitalization time.