归芍四君子汤改善围手术期乳腺癌患者皮下积液及免疫功能低下的临床研究(1)
DOI：10.16662/j.cnki.1674-0742.2017.20.010
[摘要] 目的 探讨归芍四君子汤改善围手术期乳腺癌患者皮下积液及免疫功能低下的临床疗效。方法 方便选取该院2015年1月—2017年4月初次就诊的可手术的60例乳腺癌患者随机分为两组。对照组30例：采用普通治疗，术后当天予葡萄糖等支持治疗，补液总量达1 800 mL，患者禁食禁饮6 h后恢复正常饮食；治疗组30例：采用普通治疗基础上加服用归芍四君子汤(1剂/d，早晚温服)，连续服用10 d。拔除引流管后观察患者皮下积液情况；记录引流管放置时间；记录术前2 d、术后第1天、术后第5天、术后第10天患者T细胞亚群检测值变化情况。结果 对照组有6例皮下积液，发生率为20.0%，治疗组有1例，发生率为3.3%， 差異有统计学意义(P=0.013)。在胸壁引流管放置平均时间上，对照组为(6.11±4.61)d；治疗组为(5.77±4.30)d；治疗组较对照组少， 差异无统计学意义(P=0.072)；在腋下引流管放置平均时间上，对照组为(17.11±3.28)d；治疗组为(13.42±1.99)d；治疗组较对照组显著减少，差异有统计学意义(P=0.011)。术后第1天，对照组CD3为(49.06±3.41)%、CD4为(27.91±1.88)%、CD4/CD8为(0.48±0.56)，治疗组CD3为(49.01±1.68)%、CD4为(27.77±2.59)%、CD4/CD8为(0.48±0.39)，均较术前2 d有所降低；对照组CD8为(35.86±3.73)%，治疗组CD8为(35.69±1.03)%，差异无统计学意义(P=0.069)。术后第5天，对照组CD3为(48.09±4.35)%、CD4为(25.64±1.21)%、CD4/CD8为(0.46±0.21)，治疗组CD3为(55.46±1.47)%、CD4为(34.16±4.01)%、CD4/CD8为(0.96±0.15)，治疗组较对照组升高；对照组CD8为(36.39±1.58)%，治疗组CD8为(33.23±4.07)%，治疗组较对照组降低，差异有统计学意义(P=0.034)。术后第10天，对照组CD3为(47.89±2.98)%、CD4为(27.18±3.55)%、CD4/CD8为(0.44±0.66)，治疗组CD3为(58.02±2.23)%、CD4为(40.63±0.97)%、CD4/CD8为(1.57±0.22)，治疗组较对照组显著升高；对照组CD8为(36.29±2.40)%，治疗组CD8为(31.65±1.78)%，治疗组较对照组显著降低，差异有统计学意义(P=0.013)。结论 归芍四君子汤可有效降低乳腺癌术后皮下积液的发生率，减短了引流管放置时间，提高围手术期患者的免疫力，加速患者术后康复。
[关键词] 归芍四君子汤；围手术期乳腺癌；皮下积液；引流管放置时间；免疫功能
[中图分类号] R285 [文献标识码] A [文章编号] 1674-0742(2017)07(b)-0010-04
Clinical Research on Guishao Sijunzi Tang in Improving the Seroma and Low Immune Function
CHEN Gui-fen
Department of Oncology Surgery， People's Hospital of Fujian University of Traditional Chinese Medicine， Fuzhou， Fujian Province， 350004 China
[Abstract] Objective To observe the clinical curative effect of guishao sijunzi tang in improving the serom and low immune function. Methods 60 cases of breast cancer patients diagnosed in our hospital from January 2015 to April 2017 were convenient selected and randomly divided into two groups with 30 cases in each， the control group adopted the common treatment and were given the support treatment of glucose on the day of operation， and the total amount of fluid infusion reached 1 800 mL， and the patients returned to the normal after 6 h absolute diet， and the treatment group took the guishao sijunzi tang (once each day， warm-taken decoction) for consecutive 10 days on the basis of the common treatment， and the seroma situation of patients was observed after the drainage tube removal， and the drainage replacement time was recorded and the changes of T cell subsets test value of patients in 2 d，1 d，5 d and 10 d after surgery were recorded. Results There were 6 cases with seroma， and the incidence rate was 20.0%， and in the treatment group， there was 1 case and the incidence rate was 3.3%， and the difference was statistically significant(P=0.013)， and the average time of drainage placement of walls of the chest in the treatment group was less than that in the control group[(5.77±4.30)d vs (6.11±4.61)d]， and the difference was not statistically significant(P=0.072)， and the average time of oxter drainage tube placement in the treatment group was obviously lower than that in the control group[(13.42±1.99)d vs (17.11±3.28)d]， and the difference was statistically significant(P=0.011)， and the CD3， CD4， CD4/CD8 in the control group in 1d after surgery were respectively(49.06±3.41)%，(27.91±1.88)% and (0.48±0.56)， and the CD3， CD4， CD4/CD8 in the treatment group were respectively(49.01±1.68)%，(27.77±2.59)% and (0.48±0.39) in the treatment group， which decreased compared with those in 2 days before surgery， and the difference in the CD8 between the control group and the treatment group was not statistically significant[(35.86±3.73)% vs (35.69±1.03)%]，(P=0.069)， and the CD3， CD4， CD4/CD8 in the treatment group increased compared with those in the control group in 5d after surgery[(48.09±4.35)%，(25.64±1.21)%，(0.46±0.21) vs (55.46±1.47)%，(34.16±4.01)%，(0.96±0.15)]， and the difference in the CD8 between the control group and the treatment group was statistically significant[(36.39±1.58)% vs (33.23±4.07)%]，(P=0.034)， and the CD3， CD4， CD4/CD8 in the treatment group were obviously increased compared with those in the control group[(47.89±2.98)%， (27.18±3.55)%， (0.44±0.66)% vs (58.02±2.23)%， (40.63±0.97)%，(1.57±0.22)]， and the difference in the CD8 between the control group and the treatment group [(36.29±2.40)% vs (31.65±1.78)%]， was statistically significant(P=0.013). Conclusion Guishao sijunzi tang can effectively reduce the incidence rate of postoperative seroma after breast cancer surgery， shorten the drainage tube placement time， improve the immune of patients during the perioperative period and accelerate the postoperative recovery of patients., 百拇医药(陈桂芬)
[摘要] 目的 探讨归芍四君子汤改善围手术期乳腺癌患者皮下积液及免疫功能低下的临床疗效。方法 方便选取该院2015年1月—2017年4月初次就诊的可手术的60例乳腺癌患者随机分为两组。对照组30例：采用普通治疗，术后当天予葡萄糖等支持治疗，补液总量达1 800 mL，患者禁食禁饮6 h后恢复正常饮食；治疗组30例：采用普通治疗基础上加服用归芍四君子汤(1剂/d，早晚温服)，连续服用10 d。拔除引流管后观察患者皮下积液情况；记录引流管放置时间；记录术前2 d、术后第1天、术后第5天、术后第10天患者T细胞亚群检测值变化情况。结果 对照组有6例皮下积液，发生率为20.0%，治疗组有1例，发生率为3.3%， 差異有统计学意义(P=0.013)。在胸壁引流管放置平均时间上，对照组为(6.11±4.61)d；治疗组为(5.77±4.30)d；治疗组较对照组少， 差异无统计学意义(P=0.072)；在腋下引流管放置平均时间上，对照组为(17.11±3.28)d；治疗组为(13.42±1.99)d；治疗组较对照组显著减少，差异有统计学意义(P=0.011)。术后第1天，对照组CD3为(49.06±3.41)%、CD4为(27.91±1.88)%、CD4/CD8为(0.48±0.56)，治疗组CD3为(49.01±1.68)%、CD4为(27.77±2.59)%、CD4/CD8为(0.48±0.39)，均较术前2 d有所降低；对照组CD8为(35.86±3.73)%，治疗组CD8为(35.69±1.03)%，差异无统计学意义(P=0.069)。术后第5天，对照组CD3为(48.09±4.35)%、CD4为(25.64±1.21)%、CD4/CD8为(0.46±0.21)，治疗组CD3为(55.46±1.47)%、CD4为(34.16±4.01)%、CD4/CD8为(0.96±0.15)，治疗组较对照组升高；对照组CD8为(36.39±1.58)%，治疗组CD8为(33.23±4.07)%，治疗组较对照组降低，差异有统计学意义(P=0.034)。术后第10天，对照组CD3为(47.89±2.98)%、CD4为(27.18±3.55)%、CD4/CD8为(0.44±0.66)，治疗组CD3为(58.02±2.23)%、CD4为(40.63±0.97)%、CD4/CD8为(1.57±0.22)，治疗组较对照组显著升高；对照组CD8为(36.29±2.40)%，治疗组CD8为(31.65±1.78)%，治疗组较对照组显著降低，差异有统计学意义(P=0.013)。结论 归芍四君子汤可有效降低乳腺癌术后皮下积液的发生率，减短了引流管放置时间，提高围手术期患者的免疫力，加速患者术后康复。
[关键词] 归芍四君子汤；围手术期乳腺癌；皮下积液；引流管放置时间；免疫功能
[中图分类号] R285 [文献标识码] A [文章编号] 1674-0742(2017)07(b)-0010-04
Clinical Research on Guishao Sijunzi Tang in Improving the Seroma and Low Immune Function
CHEN Gui-fen
Department of Oncology Surgery， People's Hospital of Fujian University of Traditional Chinese Medicine， Fuzhou， Fujian Province， 350004 China
[Abstract] Objective To observe the clinical curative effect of guishao sijunzi tang in improving the serom and low immune function. Methods 60 cases of breast cancer patients diagnosed in our hospital from January 2015 to April 2017 were convenient selected and randomly divided into two groups with 30 cases in each， the control group adopted the common treatment and were given the support treatment of glucose on the day of operation， and the total amount of fluid infusion reached 1 800 mL， and the patients returned to the normal after 6 h absolute diet， and the treatment group took the guishao sijunzi tang (once each day， warm-taken decoction) for consecutive 10 days on the basis of the common treatment， and the seroma situation of patients was observed after the drainage tube removal， and the drainage replacement time was recorded and the changes of T cell subsets test value of patients in 2 d，1 d，5 d and 10 d after surgery were recorded. Results There were 6 cases with seroma， and the incidence rate was 20.0%， and in the treatment group， there was 1 case and the incidence rate was 3.3%， and the difference was statistically significant(P=0.013)， and the average time of drainage placement of walls of the chest in the treatment group was less than that in the control group[(5.77±4.30)d vs (6.11±4.61)d]， and the difference was not statistically significant(P=0.072)， and the average time of oxter drainage tube placement in the treatment group was obviously lower than that in the control group[(13.42±1.99)d vs (17.11±3.28)d]， and the difference was statistically significant(P=0.011)， and the CD3， CD4， CD4/CD8 in the control group in 1d after surgery were respectively(49.06±3.41)%，(27.91±1.88)% and (0.48±0.56)， and the CD3， CD4， CD4/CD8 in the treatment group were respectively(49.01±1.68)%，(27.77±2.59)% and (0.48±0.39) in the treatment group， which decreased compared with those in 2 days before surgery， and the difference in the CD8 between the control group and the treatment group was not statistically significant[(35.86±3.73)% vs (35.69±1.03)%]，(P=0.069)， and the CD3， CD4， CD4/CD8 in the treatment group increased compared with those in the control group in 5d after surgery[(48.09±4.35)%，(25.64±1.21)%，(0.46±0.21) vs (55.46±1.47)%，(34.16±4.01)%，(0.96±0.15)]， and the difference in the CD8 between the control group and the treatment group was statistically significant[(36.39±1.58)% vs (33.23±4.07)%]，(P=0.034)， and the CD3， CD4， CD4/CD8 in the treatment group were obviously increased compared with those in the control group[(47.89±2.98)%， (27.18±3.55)%， (0.44±0.66)% vs (58.02±2.23)%， (40.63±0.97)%，(1.57±0.22)]， and the difference in the CD8 between the control group and the treatment group [(36.29±2.40)% vs (31.65±1.78)%]， was statistically significant(P=0.013). Conclusion Guishao sijunzi tang can effectively reduce the incidence rate of postoperative seroma after breast cancer surgery， shorten the drainage tube placement time， improve the immune of patients during the perioperative period and accelerate the postoperative recovery of patients., 百拇医药(陈桂芬)