五味消毒饮合沙参麦冬汤治疗鼻咽癌放射治疗后吞咽困难的疗效

Effects of Wuwei Xiaodu Decoction Combined with Shashen Maidong Decoction on Dysphagia after Radiotherapy in Patients with Nasopharyngeal Carcinoma

目的:探讨五味消毒饮合沙参麦冬汤加减对鼻咽癌患者放射治疗后吞咽困难的疗效。方法:选取2015年3月至2018年3月海南省海口市中医医院耳鼻喉科收治的鼻咽癌放射治疗后患者72例作为研究对象,随机分为对照组和观察组,每组36例。对照组给予对症治疗、基础护理及系统康复训练,观察组在对照组治疗方法的基础上给予五味消毒饮合沙参麦冬汤加减。2组均以4周为1个疗程,共治疗2个疗程,比较2组治疗前后张口受限程度及吞咽功能、中医症状积分、涎腺损伤程度、生命质量评分,以及免疫功能指标血CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)水平。结果:治疗后,观察组吞咽功能疗效等级与对照组比较,差异有统计学意义(Z=2.675,P=0.007);对照组吞咽功能治疗有效率55.6%,显著低于观察组的83.3%,2组比较差异有统计学意义(χ^(2)=6.545,P=0.011);2组中医症状积分均较治疗前显著减少(P<0.01),观察组减少均较对照组明显(均P<0.01);对照组涎腺损伤程度与治疗前比较,差异无统计学意义(Z=0.094,P=0.925),而观察组涎腺损伤程度与治疗前比较显著减轻(Z=2.421,P=0.015),且损伤程度显著轻于对照组(P<0.05);对照组CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)水平与治疗前比较,差异均无统计学意义(P>0.05),而观察组CD3、CD4^(+)、CD4^(+)/CD8^(+)显著提高(P<0.05,P<0.01),CD8^(+)水平显著下降(P<0.01)。结论:五味消毒饮合沙参麦冬汤能显著改善鼻咽癌患者放射治疗后吞咽困难症状,减轻涎腺损伤程度,改善临床症状,并能调节患者的免疫功能,提高患者的生命质量。

Objective:To investigate the effects of Wuwei Xiaodu Decoction combined with Shashen Maidong Decoction on dysphagia after radiotherapy in patients with nasopharyngeal carcinoma.Methods:Seventy-two patients with nasopharyngeal carcinoma after radiotherapy in the Department of Otolaryngology,Haikou Hospital of Traditional Chinese Medicine from March 2015 to March 2018 were enrolled and randomly divided into a control group and an observation group,with 36 cases in each group.The patients in the control group received symptomatic treatment,basic nursing,and systematic rehabilitation training,while those in the observation group received additional modified Wuwei Xiaodu Decoction and Shashen Maidong Decoction on the basis of the therapeutic protocol of the control group.All patients were treated for two courses of treatment(four weeks as one course).The pre-and post-treatment degrees of restricted mouth opening,swallowing functions,symptom scores of traditional Chinese medicine(TCM),salivary gland damage,quality of life scores,and serum levels of immune function indicators CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+) of the two groups were compared.Results:After treatment,there was a statistically significant difference in the efficacy grade of swallowing function between the observation group and the control group(Z=2.675,P=0.007).The effective rate of swallowing function in the control group was 55.6%,lower than 83.3%in the observation group(χ^(2)=6.545,P=0.011).After treatment,TCM syndrome scores in the two groups were lower than those before treatment(P<0.01),and the decrease in the observation group was more obvious than that in the control group(both P<0.01).No significant difference in the severity of salivary gland damage was observed in the control group before and after treatment(Z=0.094,P=0.925),while the salivary gland damage in the observation group was relieved compared with that before treatment(Z=2.421,P=0.015).Additionally,after treatment,the damage in the control group was more severe than that in the observation group(P<0.05).No significant difference in the levels of CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+) was observed in the control group before and after treatment(P>0.05),while in the observation group,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+) levels were elevated(P<0.05,P<0.01),and CD8^(+) level was reduced after treatment(P<0.01).Conclusion:Wuwei Xiaodu Decoction combined with Shashen Maidong Decoction can significantly improve dysphagia in patients with nasopharyngeal carcinoma after radiotherapy,relieve salivary gland damage,improve clinical symptoms,regulate the immune function of patients,and improve the quality of life of patients.