非小细胞肺癌术后患者症状分布规律及升陷汤加减的干预效果

Symptoms Distribution Rules of Postoperative Non-small Cell Lung Cancer Patients and Intervention Effect of Modified Shengxian Decoction (升陷汤)

目的总结非小细胞肺癌(NSCLC)患者术后症状的分布规律及中医核心病机,并在病机指导下进行中药辨证加减治疗,观察症状及生活质量改善情况。方法前期纳入观察组NSCLC患者49例,术后连续4个月进行症状动态变化观察,聚类获得症状群,总结中医核心病机;后期纳入NSCLC术后4~6个月内的中药干预组患者48例,治疗以核心病机为指导确定中医药主方,辨证加减化裁,疗程为1个月。制定肺癌术后症状观察量表进行症状评分,生活质量评价采用肺癌患者生活质量调查问卷。评价治疗前后患者的症状及生活质量改善情况。结果 NSCLC患者术后症状以气短、神疲乏力、咳嗽、自汗、胸闷、咯痰、口干等最为多见,并以此组成主要症候群;未经药物干预,与术后1个月比较,术后2、3、4个月的症状总评分均明显下降(P <0. 05),术后2个月与以后的症状评分比较差异无统计学意义(P> 0. 05)。以大气下陷核心病机为指导,确定升陷汤为主方进行辨证加减干预,治疗前以气短为主要症状,其次为咳嗽、咯痰、口干;治疗后的症状总评分明显低于治疗前(P <0. 01),其中气短、咳嗽、咯痰、胸闷、神疲乏力、易感冒、食欲不振、失眠、口干、心悸、自汗的单项积分均较治疗前下降(P <0. 05或P <0. 01);生活质量评估在功能方面,改善躯体、角色、情绪、社会功能以及总健康状况的有效率分别为95. 83%、87. 50%、97. 92%、100%、100%;改善疲倦、心悸、气促及咳嗽的心肺功能异常症状的有效率分别为97. 67%、87. 80%、95. 56%、87. 50%。结论 NSCLC术后患者以气短、神疲乏力、咳嗽、自汗、胸闷、咯痰、口干等为主组成症状群,其中医核心病机为大气下陷;升陷汤辨证加减治疗NSCLC术后患者,可有效改善患者术后症状,显著提升患者生活质量。

Objective To summarize postoperative symptom distribution rules in non-small cell lung cancer(NSCLC) patients and its core pathogenesis in traditional Chinese medicine(TCM). Under the guide of pathogenesis,to conduct modified TCM treatment according to syndrome differentiation,and to observe improvement in the symptoms and quality of life. Methods Firstly,49 NSCLC patients were included in observation group,and changes of symptoms and improvement of quality of life were observed for 4 consecutive months after operation to obtain symptom groups by clustering and to summarize the core TCM pathogenesis. Afterwards,48 NSCLC patients treated with TCM intervention within 4 to 6 months after the operation were included in the group. The treatment was to determine a main TCM prescription under the core pathogenesis,and to modify it according to syndrome differentiation.The treatment lasted for 1 month. An observation scale on postoperative symptoms in lung cancer was developed to score the symptoms,and the quality of life was evaluated by quality of life questionnaire for lung cancer patients(EORTC-QLQ-LC13). The improvement of symptoms and life quality after the treatment were evaluated. Results Postoperative symptoms in NSCLC patients were mainly composed of shortness of breath,fatigue,cough,spontaneous sweating,chest tightness,expectoration,dry mouth. And these constituted the main symptom group. Without the medicinal intervention,the total symptom scores were significantly decreased 2,3 and 4 months after the operation as compared to that 1 month after the operation(P < 0. 05). There was no significant difference in symptom scores 2 months and later after the operation(P > 0. 05). Under the guidance of the core pathogenesis of major-qi collapse,Shengxian Decoction(升陷汤) was determined as the main prescription for modification and intervention according to syndrome differentiation. Before the treatment,shortness of breath was the main symptom,followed by cough,expectoration and dry mouth. After the treatment,the total symptom score was significantly lower than before(P < 0. 01).Among them,the symptom scores of shortness of breath,cough,expectoration,chest tightness,fatigue,susceptibility to cold,loss of appetite,insomnia,dry mouth,palpitations and spontaneous sweating were all decreased compared with those before the treatment(P < 0. 05,or P < 0. 01). In terms of functions in life quality evaluation,effective rates in improving physical,role,emotional and social functions and overall health status were 95. 83%,87. 50%,97. 92%,100% and 100%,respectively. The effective rates in improving abnormal symptoms of cardio-pulmonary function like fatigue,palpitations,shortness of breath and cough were 97. 67%,87. 80%,95. 56% and 87. 50%,respectively. Conclusion Postoperative NSCLC patients are mainly characterized by a symptom group including shortness of breath,fatigue,cough,spontaneous sweating,chest tightness,expectoration and dry mouth. The core TCM pathogenesis is major-qi collapse. Modified Shengxian Decoction can effectively improve postoperative symptoms in NSCLC patients and significantly improve their quality of life.