姚菲 荣震 石玮 李春姗

【摘 要】 目的：观察 “温阳化饮”联合常规西医治疗恶性胸腔积液的临床疗效。方法：将125例伴有恶性胸腔积液的患者，随机分为对照组62例和治疗组63例，两组均予常规胸腔穿刺引流胸水。对照组单纯予白介素-2胸腔灌注，治疗组采用胸腔灌注白介素-2联合中药柴胡桂枝干姜汤口服及中医火针针灸四门（云门、期门、章门、京门）控制胸水，疗程均为6周。治疗后观察两组治疗恶性胸腔积液的临床获益率、胸水缓解期及药物不良反应。结果：经6周治疗，治疗组的胸水缓解有效率为42.4%，对照组为33.8%，差异有统计学意义（P<0.05）；治疗组的临床获益有效率为84.8%，对照组为64.2%，差异有统计学意义（P<0.05）；胸水缓解期，治疗组≥3个月复发的患者比例为15.6%，对照组为9.7%，两组比较差异有统计学意义（P<0.05）。结论：“阳虚水停”是恶性胸腔积液的关键病因，在灌注白介素-2基础上加入中医“温阳化饮”中药柴胡桂枝干姜汤联合火针针刺四门治疗，不良反应低，能有效提高胸水缓解率，推迟胸水复发时间，一定程度上提高患者的生存质量，值得临床运用推广。

【关键词】 恶性胸腔积液；阳虚水停；柴胡桂枝干姜汤；火针

【中图分类号】R561 【文献标志码】 A【文章编号】1007-8517（2018）02-0096-04

Abstract：Objective To observe the clinical effect of “warming yang to promote diuresis” to malignant fleural effusion. Methods 125 patients suffering from malignant fleural effusion are randomly divided into two groups： control group 62 patients and treatment group 63 patients. All patients are treated by thoracic drainage and delivered IL-2 to the thoracic. The Chaihu Guizhi Ganjiang formular and fire needles in four men（ Yun men， Qi men， Zhang men and Jing men） are applied in study group for 6 weeks. After that. Changes in efficiency of fleural effusion， clinical benefit rate， remission time and adverse reactions between the two groups are compared. Results After 6 weeks of treatment， the efficiency of treatment group of was 42.4%， while 33.8% in the control group， the difference was statistically significant（P<0.05）； the clinical benefit rates of the treatment group was 84.8%， while 64.2% in the control group，there was significant difference between them（P<0.05）； the proportion of patients with remission time longer than 3 months， treatment group was 15.6%， the control group was 9.7%， compared with two group there was statistical significance（P<0.05）. Conclusion Deficiency of Yang and Fluid Retention are the key cause of malignant fleural effusion. In the study we receive higher efficiency and longer remission time in the study group by adding Chaihu Guizhi Ganjiang formular and fire needles to the treatment and reduce the patients discomfort as well as improve the quality of survival.

Keywords：Malignant fleural effusion； Deficiency of Yang and Fluid Retention； Chaihu Guizhi Ganjiang formular；Fire needles

惡性胸腔积液临床症状多表现为咳嗽、气喘、胸痛等，常见于原发性支气管肺癌、乳腺癌等胸膜转移，治疗难度大，预后差，是肿瘤临床治疗的难题[1-2]。恶性胸腔积液患者平均生存期为3.3个月，治疗不及时可危及生命[3]。恶性积液归属于中医学“悬饮”范畴，《内经》中病机十九条提到“诸病水液，澄澈清冷，皆属于寒”；《素问》中提到“阳化气，阴成形”。中医认为其病属本虚标实，阳虚为本，水饮壅盛为标。饮为阴邪，遇寒而聚而凝，得阳则气化水行。治疗寒饮当以温阳化饮为治疗原则，方能振奋阳气，开发腠理，通行水道。临床上常用葶苈大枣泻肺汤、小青龙汤、苓桂术甘汤[4-6]等以温肺化水之法施治，效果较佳。笔者用“温阳化饮”法联合西医共治恶性胸腔积液患者63例，取得较好的临床疗效。……