彝药五气朝阳草治疗肿瘤放化疗后不良反应临证运用

肿瘤放化疗治疗后易引起各类不良反应,中药对证治疗缓解化疗后的各类不良反应,具有明显的效果。文章介绍彝药五气朝阳草在肿瘤放化疗后不良反应的中药治疗中的运用经验,附案例2则。

食管鳞癌患者同步放化疗期间发生严重淋巴细胞减少的影响因素分析及预测模型建立

目的 分析食管鳞癌(ESCC)患者同步放化疗(CCRT)期间发生严重绝对淋巴计数(ALC)减少的影响因素,建立ESCC患者CCRT期间发生严重ALC减少的预测模型并进行效能验证。方法 收集接受CCRT的286例ESCC患者的临床基线资料、放化疗方案,放疗剂量学参数等资料。根据治疗前ALC及治疗期间每周ALC,分析CCRT期间ALC动力学。根据患者CCRT期间是否发生严重ALC减少分为严重ALC减少组与非严重ALC减少组,比较两组收集的上述资料,并对CCRT期间发生严重ALC减少患者进行多因素Logistic回归分析筛选ESCC患者CCRT期间发生严重ALC减少的独立影响因素,基于影响因素构建严重ALC减少的风险预测模型(列线图)。采用受试者工作特征(ROC)、一致性指数(C-index)、校准曲线、决策分析(DCA)曲线评估列线图模型的区分度、一致性、校准度及临床适用性。结果 ESCC患者在CCRT期间ALC呈现逐渐下降趋势(P<0.05)。两组BMI、治疗前ALC、平均椎体剂量(MVD)、循环免疫细胞估计剂量(EDIC)比较差异有统计学意义(P均<0.05)。BMI(OR=0.829,95%CI:0.760~0.900)、治疗前ALC(OR=0.412,95%CI:0.253~0.648)、MVD(OR=1.079,95%CI:1.011~1.155)和EDIC(OR=1.711,95%CI:1.422~2.292)是ESCC患者CCRT期间发生严重ALC减少的独立影响因素(P<0.05)。基于上述影响因素构建列线图模型。列线图模型预测CCRT期间发生严重ALC减少的ROC下面积为0.799(95%CI:0.748~0.850);C-index为0.789;预测ALC减少风险与实际发生的风险较一致;预测发生严重ALC减少的可能在0.25~0.90概率范围内具有较好的临床适用性。结论 ESCC患者在CCRT期间发生严重ALC减少的独立影响因素为BMI、治疗前ALC、MVD、EDIC,基于上述影响因素建立的预测ESCC患者在CCRT期间发生严重ALC减少的列线图模型具有良好的区分度、一致性、校准度及临床实用性。

护理干预对中晚期宫颈癌放化疗患者不良反应和生存质量的影响

目的：探讨护理干预对妇科恶性肿瘤放化疗患者不良反应和生存质量的影响。方法选取2010年至2011年山西煤炭中心医院收治的妇科恶性肿瘤患者160例，将其随机分为观察组和对照组各80例，分别接受护理干预和常规护理，将2组患者不良反应和生存质量进行比较。结果观察组患者的生存质量优良率为87.5％，显著高于对照组；不良反应发生率为31.3％显著低于对照组。结论在妇科恶性肿瘤患者的放化疗过程中进行有效护理干预，可以降低不良反应，提高患者生存质量，值得推广应用。

引火汤在恶性肿瘤放、化疗不良反应中的应用

君火、相火共同维持机体的正常活动。肾中相火,居下焦,一旦上浮,可呈下真寒、上假热的证候。阳虚上浮之火,宜温、宜引。引火汤原为治咽喉肿痛属阴蛾者所设,补真阴以制阳,使真阳归其本位,旨在调和机体阴阳。后世根据其病机及组方之理,用于各类辨证属肾水不足、火不归元的疾病,收效显著。放化疗伤津耗气,日久致患者气阴两伤,肾阴不足,无以潜藏肾阳,则相火不藏,或肾阳亏损,命门火衰,则阳浮于外,多表现一派虚火之象,符合引火归元立法原则,临床应用引火汤屡试不爽。不独引火汤,引火归元法及其类方可根据病情灵活应用,可成为缓解恶性肿瘤放、化疗后症状,提高身体素质的重要治法。

糖皮质激素在肿瘤内科临床应用中的疗效和安全性

目的研究在肿瘤内科临床治疗中应用糖皮质激素的疗效和安全性。方法56例肿瘤内科患者,随机分为对照组和观察组,每组28例。对照组给予低剂量糖皮质激素治疗,观察组给予高剂量糖皮质激素治疗。对比两组放化疗不良反应及并发症发生情况。结果两组恶心呕吐、脊髓压迫、骨髓抑制、颅内高压发生率对比差异均无统计学意义(P>0.05)。对照组发生水肿23例(82.1%)、体力不支18例(64.3%)、过敏17例(60.7%)、肝功能损害21例(75.0%),观察组发生水肿3例(10.7%)、体力不支4例(14.3%)、过敏3例(10.7%)、肝功能损害5例(17.9%);观察组水肿、体力不支、过敏、肝功能损害发生率均低于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率35.7%(10/28)高于对照组的10.7%(3/28),差异具有统计学意义(P<0.05)。结论在肿瘤内科给予糖皮质激素治疗可取得良好疗效,但存在一定并发症。医师要视病情,观察患者身体状况,根据个体差异严格控制用药剂量,减少患者机体并发症,缓解患者疼痛感,让抗肿瘤治疗效果得到提高,提升患者生存质量,延长其生存期。

Therapeutic observation of grain-sized moxibustion for chemotherapy-induced myelosuppression for non-small cell lung cancer

Objective: To observe the clinical efficacy of grain-sized moxibustion in treating chemotherapy-induced myelosuppression for non-small cell lung cancer (NSCLC) and its effect on quality of life (QOL). Methods: Eighty NSCLC patients admitted to the Inpatient Department of Zhejiang Cancer Hospital between September 2016 and March 2018 were recruited and divided into an observation group and a control group by random number method, with 40 cases in each group. The two groups both received chemotherapy with paclitaxel plus cisplatin (TP regimen). The control group received oral administration of leucogen tablets starting from the first day of chemotherapy, 20 mg each time, three times a day, for consecutive 14 d;the observation group was additionally given grain-sized moxibustion, once a day, five days per week at a two-day interval, until the fourteenth day. The myelosuppression severity was observed and compared between the two groups prior to chemotherapy, at the 3rd, 7th and 14th days of chemotherapy;the QOL in the two groups was evaluated before chemotherapy, at the 14th and 21st days of chemotherapy. Results: Regarding myelosuppression, the peripheral blood indicators increased significantly at the 3rd day of chemotherapy in both groups (P<0.05 or P<0.01);at the 7th and 14th days of chemotherapy, the peripheral blood indicators presented a decreasing tendency in the two groups, but the level in the observation group was still significantly higher than that before chemotherapy (P<0.01);at the 3rd, 7th and 14th days of chemotherapy, the peripheral blood indicators in the observation group were higher than those in the control group (P<0.05 or P<0.01);the occurrence rate of myelosuppression in the observation group was significantly lower than that in the control group (P<0.01). The QOL score in the observation group was markedly higher than that in the control group at the 14th and 21st days of chemotherapy (both P<0.05). Conclusion: Grain-sized moxibustion can effectively improve myelosuppression after chemotherapy for NSCLC, reducing its occurrence and enhancing the patient's QOL.

Scalp acupuncture combined with body acupuncture for 32 cancer cases with intractable hiccups after radiochemotherapy

Objective： To observe the therapeutic effect of scalp acupuncture combined with body acupuncture in treating cancer patients with intractable hiccups after radiochemotherapy. Methods; Thirty-two cancer patients with intractable hiccups after radiochemotherapy who met the inclusion criteria were selected. The Line 2 Lateral to Forehead （MS 3） of scalp stimulation areas as well as body acupoints including Danzhong （CV 17）, Zhongwan （CV 12）, bilateral Cuanzhu （BL 2）, Neiguan （PC 6）, Zusanli （ST 36） and Taichong （LR 3） were punctured. The treatment was given once a day, 5 treatments constituted a course, and the efficacy was evaluated after 2 treatment courses. Results： After 10 treatments, 26 cases were cured, 4 cases were improved, and 2 cases were invalid, and the total effective rate was 93.8%. Conclusion： Scalp acupuncture combined with body acupuncture in treating intractable hiccups in cancer patients after radiochemotherapy has reliable therapeutic effect, and it is easy-to-operate and can effectively alleviate the suffering of patients with less adverse reaction.