以传统艾灸为对照评价不同配穴热敏灸治疗晚期肺癌化疗后白细胞减少症的有效性及安全性

Evaluate the Efficacy and Safety of Heat-sensitive Moxibustion in the Treatment of Neutropenia after Chemotherapy for Advanced Lung Cancer with Traditional Moxibustion as Control

目的本研究旨在以传统艾灸为对照比较不同取穴探查的热敏灸对化疗后白细胞减少症的影响。方法选取我院80例肺癌晚期化疗后白细胞减少症患者,采用随机数字表法分为A、B两组,A组依据我科前期研究取穴探查;B组依据国内同行的大数据分析的取穴探查。连续2日每日1次对A、B两组患者按照热敏灸操作规范进行最多20 min穴位热敏探查,以两日中是否获得至少一次穴位热敏化作为最终统计分析的组内分层条件,获得热敏感者列入A1/B1组,采用后续热敏灸的施灸手法,未获得热敏感者列入B1/B2组,采用传统单点温和灸20 min,比较A/B两组及各亚组在第1,3,5,8天及第15天后评价疗效差异。结果①A组较B组更易获得热敏感(P<0.05)。②A、B组及A1、A2组均可升高白细胞计数,且A组较B组升高速度更快(第5天vs.第8天),采用传统灸法的A2、B2组均无显著变化。③A、B组均可快速改善中医症状积分,且随着结束时间的延长而减弱,分别在第15日和第8日恢复至治疗开始前的水平。④A、B组均可改善患者生活质量(P<0.05)。⑤A、B两组均未出现重度骨髓抑制、肝肾功能及心功能损害。结论较传统灸法,不管何种配穴的热敏灸均可获得更佳的升高白细胞速度及升高白细胞力度,且均可迅速改善中医症状,但随热敏灸结束时间的延长而能力减弱。选取足三里、肺俞、气海、关元、膏肓穴进行穴位探查,均可更快更易获得穴位热敏感,且该疗法较其他热敏灸的升高白细胞起效时间更短、力度更强且持续更久。

Objective To compare the effects of heat-sensitive moxibustion,traditional moxibustion and different acupoint selection on neutropenic myelosuppression.Methods 80 patients with neutropenic myelosuppression after advanced chemotherapy of lung cancer in our hospital were randomly divided into two groups:group A and group A,according to our experience.Group B selected big data acupoint selection selected by Tan Li and others based on clinical use frequency.Patients in group A and B were investigated for moxibustion sensation of heat-sensitive moxibustion.Results(1)Group A was more likely to acquire heat sensitivity than group B(P<0.05).(2)Groups A,B and A1,A2 could increase the white blood cell count,and group A increased faster than group B(5 days vs.8 days),there was no significant change in groups A2 and B2 using traditional moxibustion.(3)Both groups A and B could rapidly improve the TCM symptom scores,and they weakened with the prolongation of the end time,respectively in groups A and B.On the 15th and 8th day,it returned to the level before treatment.(4)Both groups A and B could improve the quality of life of the patients(P<0.05).(5)Neither group A nor B had severe bone marrow suppression,liver Renal and cardiac function impairment.Conclusion Heat-sensitive moxibustion combined with Qihai,Guanyuan,Zusanli(Shuang),Feishu(Shuang)and Plaster(Shuang)can significantly improve the recovery of granulocyte count in patients with neutropenic myelosuppression after chemotherapy for lung cancer,which is suitable for clinical application.