五味消毒饮熏洗联合心理疏导综合干预阿帕替尼后手足综合征(热毒壅盛)随机平行对照研究
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摘要
[目的]观察五味消毒饮熏洗联合心理疏导护理综合干预阿帕替尼后手足综合征(热毒壅盛)疗效。[方法]使用随机平行对照方法,将60例住院患者按信封法随机分为两组。心理疏导:使患者了解化疗和靶向药物副作用表现、机理和处理措施,减少恐惧心理;皮肤护理:避免手足部摩擦、受压,避免激烈运动和体力劳动,减少手足接触热水次数(包括洗碗碟和热水澡);避免涂刺激性药物及酒精、碘酒;避免接触化学洗涤剂;穿鞋舒适宽松,用减震鞋垫,坐或卧位将手足放在较高位置;避免阳光曝晒,涂抹防晒霜,冬季晒太阳也只能在窗户后。对照组60例尿素软膏外涂;复合维生素B,2片/次,2次/d;疼痛明显塞来昔布,0.2g/次,1次/d。治疗组60例五味消毒饮熏洗(金银花、蒲公英各30g,野菊花20g,紫花地丁30g,紫草、赤芍各15g,当归12g,大黄10g,地黄30g,侧柏叶15g,皮损明显加丹皮、苦参、徐长卿各15g);手足麻木加海风藤15g,路路通30g,川芎10g;皮肤瘙痒加蛇床子、地肤子各15g,蝉蜕10g,上药煎制200mL/袋,1袋/次,加42℃温水熏洗40min,用保鲜膜包裹足部红斑处。连续治疗2周为1疗程。观测临床表现、红肿消除时间、疼痛缓解时间、手足综合征积分(中医证候积分)、皮肤病生活质量指数(DLQI)、不良反应。治疗1疗程(2周),判定疗效。[结果]治疗组痊愈10例,有效18例,无效2例,总有效率93.33%;对照组痊愈6例,有效10例,无效14例,总有效率53.33%;治疗组疗效优于对照组(P<0.05)。红肿消除时间、疼痛缓解时间治疗组改短于对照组(P<0.05)。DLQI、中医证候积分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]五味消毒饮熏洗联合心理疏导护理综合干预阿帕替尼后手足综合征(热毒壅盛),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of Wuwei Xiaodu decoction fumigation combined with psychological counseling and nursing intervention on apatinib hind hand-foot syndrome. [Methods] Using random parallel control method, 60 hospitalized patients were randomly divided into two groups according to envelope method. Psychological counseling: to make patients understand the side effects of chemotherapy and targeted drugs, mechanism and treatment measures to reduce fear; skin care: to avoid hand and foot friction, pressure, avoid vigorous exercise and physical labor, reduce hand and foot contact with hot water(including dishes and hot baths); to avoid irritating drugs and alcohol, iodine wine; avoid contact with chemical detergents; wear shoes comfortable and loose, with shock-absorbing insoles, sit or lie in a higher position; avoid sun exposure, apply sunscreen, winter sun can only be in the window. Control group 60 cases of urea ointment topical application; vitamin B, 2 tablets/time, 2 times/day; pain significantly celecoxib, 0.2g/time, once a day. 60 cases in the treatment group were fumigated and washed with Wuwei disinfection drink(honeysuckle and dandelion 30 g each, wild chrysanthemum 20 g, violet flower digitalis 30 g, shikong and red peony 15 g each, angelica sinensis 12 g, rhubarb 10 g, rehmannia 30 g, platycladus orientalis 15 g each, skin lesions were markedly added with Danpi, sophora flavescens and Xuchangqing 15 g), hand-foot numbness with Haifengteng 15 g, Lulutong 30 g, Chuanxiong 10 g, skin pruritus plus Fructus Cnidii and Fructus Corydalis are 15 g each, 10 g cicada molt, 200 mL/bag decocted with Chinese medicine, 1 bag per time, fumigated and washed for 40 minutes with 42℃ warm water, and covered the foot erythema with preservative film. Continuous treatment for 2 weeks was 1 courses. Clinical manifestations, redness and swelling elimination time, pain relief time, hand-foot syndrome score(TCM syndrome score), dermatosis quality of life index(DLQI), adverse reactions were observed. The course of treatment was 1 weeks(2 weeks), and the curative effect was judged. [Results] In the treatment group, 10 cases were cured, 18 cases were effective, 2 cases were ineffective, the total effective rate was 93.33%; in the control group, 6 cases were cured, 10 cases were effective, 14 cases were ineffective, the total effective rate was 53.33%; the curative effect of the treatment group was better than that of the control group(P<0.05). The time of redness elimination and pain relief were shorter in the treatment group than in the control group(P<0.05). The two groups of DLQI and TCM syndrome scores were improved(P<0.01), and the improvement of the treatment group was better than that of the control group(P<0.01). [Conclusion] Wuwei Xiaodu decoction fumigation and washing combined with psychological counseling and nursing intervention in the treatment of apatinib hind hand-foot syndrome(hyperactivity of heat and toxicity), the effect is satisfactory, no serious adverse reactions, it is worth promoting.
[Objective] To observe the effect of Wuwei Xiaodu decoction fumigation combined with psychological counseling and nursing intervention on apatinib hind hand-foot syndrome. [Methods] Using random parallel control method, 60 hospitalized patients were randomly divided into two groups according to envelope method. Psychological counseling: to make patients understand the side effects of chemotherapy and targeted drugs, mechanism and treatment measures to reduce fear; skin care: to avoid hand and foot friction, pressure, avoid vigorous exercise and physical labor, reduce hand and foot contact with hot water(including dishes and hot baths); to avoid irritating drugs and alcohol, iodine wine; avoid contact with chemical detergents; wear shoes comfortable and loose, with shock-absorbing insoles, sit or lie in a higher position; avoid sun exposure, apply sunscreen, winter sun can only be in the window. Control group 60 cases of urea ointment topical application; vitamin B, 2 tablets/time, 2 times/day; pain significantly celecoxib, 0.2g/time, once a day. 60 cases in the treatment group were fumigated and washed with Wuwei disinfection drink(honeysuckle and dandelion 30 g each, wild chrysanthemum 20 g, violet flower digitalis 30 g, shikong and red peony 15 g each, angelica sinensis 12 g, rhubarb 10 g, rehmannia 30 g, platycladus orientalis 15 g each, skin lesions were markedly added with Danpi, sophora flavescens and Xuchangqing 15 g), hand-foot numbness with Haifengteng 15 g, Lulutong 30 g, Chuanxiong 10 g, skin pruritus plus Fructus Cnidii and Fructus Corydalis are 15 g each, 10 g cicada molt, 200 mL/bag decocted with Chinese medicine, 1 bag per time, fumigated and washed for 40 minutes with 42℃ warm water, and covered the foot erythema with preservative film. Continuous treatment for 2 weeks was 1 courses. Clinical manifestations, redness and swelling elimination time, pain relief time, hand-foot syndrome score(TCM syndrome score), dermatosis quality of life index(DLQI), adverse reactions were observed. The course of treatment was 1 weeks(2 weeks), and the curative effect was judged. [Results] In the treatment group, 10 cases were cured, 18 cases were effective, 2 cases were ineffective, the total effective rate was 93.33%; in the control group, 6 cases were cured, 10 cases were effective, 14 cases were ineffective, the total effective rate was 53.33%; the curative effect of the treatment group was better than that of the control group(P<0.05). The time of redness elimination and pain relief were shorter in the treatment group than in the control group(P<0.05). The two groups of DLQI and TCM syndrome scores were improved(P<0.01), and the improvement of the treatment group was better than that of the control group(P<0.01). [Conclusion] Wuwei Xiaodu decoction fumigation and washing combined with psychological counseling and nursing intervention in the treatment of apatinib hind hand-foot syndrome(hyperactivity of heat and toxicity), the effect is satisfactory, no serious adverse reactions, it is worth promoting.
引文
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[16]卢淑娇,毛世旺,施勇.甲磺酸阿帕替尼引发手足综合征五例临床分析[J].中国全科医学,2017,20(18):2267-2270.
[17]林友燕,方晓,林小琴.药蜡治疗阿帕替尼所致手足综合征30例[J].上海针灸杂志,2016,35(12):1462-1463.
[18]黄春英.京万红软膏可治疗希罗达所致手足综合征[J].护理学报,2009,16(16):42.
[19]邓中甲.方剂学[M].7版.北京:中国中医药出版社,2010:86.
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[21]宋亚玲,王红梅,倪付勇,等.金银花中酚酸类成分及其抗炎活性研究[J].中草药,2015,46(4):490-495.
[2]田春艳,彭仁,白婷婷,等.阿帕替尼不同起始剂量治疗晚期胃癌不良反应及疗效观察[J].实用肿瘤杂志,2018,33(1):66-69.
[3]张水华,梅其炳,潘学营,等.化疗药物诱导的手足综合症[J].中国临床药理学与治疗学,2009,14(2):210-213.
[4]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-01-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[5]郭远超,张伶俐,王丹青,等.化疗药物与手足综合征[J].中国肿瘤临床,2009,36(6):357-360.
[6]孙昕.中西医结合防治手足综合征的临床研究[D].北京:北京中医药大学,2013.
[7]杜娟,刘宝瑞.阿帕替尼治疗二例晚期难治性胃癌的临床观察[J].中华肿瘤杂志,2016,38(8):636-638.
[8]朱孝娟,李杰.手足综合征中医临床治疗方式浅析[J].中华中医药杂志,2015,30(11):4032-4035.
[9]陈文晟,刘晓燕,金川,等.大剂量维生素B6预防卡培他滨所至手足综合征的疗效分析[J].广西医学,2009,31(1):61-62.
[10]徐巧霞.乳腺癌患者使用里葆多化疗致手足综合征的护理体会[J].当代护士(上旬刊),2016(4):100-101.
[11]王晓玲,赵天恩,张喜芹.简体中文版皮肤病生活质量指标信度和效度初探[J].中华流行病学杂志,2004,25(9):791-793.
[12]常忠莲,万冬桂.加味补阳还五汤防治希罗达所致手足综合征45例[J].中国中医药信息杂志,2005,12(6):63-64.
[13]王玲,焦智民,李平.中药内服外洗治疗希罗达所致中重度手足综合征8例[J].中医研究,2006,19(4):41-43.
[14]张若燕,李利亚,呙清临.加味黄芪桂枝五物汤防治希罗达相关性手足综合征的临床观察[J].辽宁中医杂志,2007,34(6):783-784.
[15]熊晓华,卢晶.加味八珍汤防治希罗达致手足综合征30例[J].中国中医药现代远程教育,2015,13(22):48-49.
[16]卢淑娇,毛世旺,施勇.甲磺酸阿帕替尼引发手足综合征五例临床分析[J].中国全科医学,2017,20(18):2267-2270.
[17]林友燕,方晓,林小琴.药蜡治疗阿帕替尼所致手足综合征30例[J].上海针灸杂志,2016,35(12):1462-1463.
[18]黄春英.京万红软膏可治疗希罗达所致手足综合征[J].护理学报,2009,16(16):42.
[19]邓中甲.方剂学[M].7版.北京:中国中医药出版社,2010:86.
[20]高学敏.中药学[M].北京:中国中医药出版社,2007.
[21]宋亚玲,王红梅,倪付勇,等.金银花中酚酸类成分及其抗炎活性研究[J].中草药,2015,46(4):490-495.