顶部连接后台

搜索
关于公布2019年烟台市中医医院公开招聘 第二批体检人员名单的通知

公告通知:

版权所有:烟台市中医医院    网站备案:鲁ICP备11026673号-1     总服务台咨询电话:0535—6597085
地址:山东省烟台市幸福路39号    乘车路线:乘2路、16路、26路、47路、48路、70路、80路、82路直达
网站建设:中企动力 烟台      后台管理
 
安卓手机APP扫码下载 手机二维码 微信服务号 微信公众号 支付宝公众号
>
术后康复指导 Post-operative rehabilitation guidance

肿瘤科特色 Oncology Feature

术后康复指导 Post-operative rehabilitation guidance

Rehabilitation guidance after tumor operation

After surgery, the tumor patients will have a long recovery stage. Cancer rehabilitation is to arouse the doctors and patients, family and society, comprehensive use of various technical measures to help patients with the greatest degree of recovery of physical and mental health, and active social occupation ability. Tumor rehabilitation involves a wide range of subjects, including psychological, drug, exercise, diet and life.

1.LungCancer

In recent years, the incidence of lung cancer is increasing rapidly, and people's vigilance against lung cancer is also increasing. As lung cancer screening technology is getting more and more advanced, moreearly lung cancer patients can be diagnosed and treated by surgery. Persistent cough and decreased respiratory function after pneumonectomy are common clinical symptoms after lung cancer surgery.

(1) The occurrence of persistent cough may be related to bronchial traction, lymph node dissection, diaphragm elevation, gastro esophageal reflux and other factors. Although postoperative cough can help expectoration and remove airway secretions, frequent and severe cough has a serious impact on the quality of life of patients. Western medicine in the treatment of the chronic cough, etiology, treatment of commonly used antitussive and expectorant treatment therapy, but the treatment effect of single target, limited clinical efficacy. TCM treatment based on syndrome differentiation is of great significance for cough after lung cancer operation. We Division in the long-term clinical practice summed up the "Kangfei Sanjie Decoction", according to the patients with dialectical type appropriate chemical process, achieved good curative effect in the treatment of complications of lung cancer surgery. For patients with stubborn cough of lung cancer, they can cooperate with "Zhike Pingchuan powder" point application and Chinese medicine diet therapy, which can relieve cough symptoms to varying degrees.

(2) Respiratory function is an important factor in determining the quality of life of lung cancer patients. As part of the lung tissue was removed, the effective ventilation area was reduced, the lung mechanics and pulmonary ventilation function were destroyed, and the exercise tolerance of the patients decreased. At present, there are few clinical researches on lung rehabilitation after lung cancer surgery, and the sample size is small, which has not been popularized in China. And Chinese medicine in improving respiratory function, combined with internal and external therapies, the curative effect is outstanding. We usually desirable TCM eight Duanjin exercise, acupuncture therapy (acupoints bilateral chize, Neiguan and Zusanli), both on pulmonary function of patients is improved.

2.Gastric Cancer

Surgery is the first choice for radical treatment of gastric cancer. In addition to common complications such as infection and bleeding, there will be emptying disorder, bile reflux, dumping syndrome, biliary and pancreatic disease and long-term malnutrition, which often brings pain and trouble to the patients. The causes of these symptoms are the operation of the vague nerve in the operation, which leads to the decrease of the secretory function of the organs such as the liver, the bile, the pancreas and the intestines, the decline of the contractile function of the gallbladder, the obstruction of emptying, the deficiency of all kinds of digestive fluid in the intestine, the deficiency of various digestive enzymes, and the weakening of the intestinal peristalsis, which makes the digestion and absorption of protein and fat.Therefore, diet care is very important for gastric cancer after operation. First select the digestible, high protein, low sugar, the amount of fat, stick a little, avoid excessive accumulation of gastrointestinal meal, so as not to cause indigestion, dilute apart. The principle of eating mild food is to achieve reasonable collocation and balanced nutrition and avoid irritating, hypersensitive, hypertonic foods and supercoiled and hypothermal food.

TCM believes that deficiency syndrome is most common after gastric cancer surgery, mostly manifested as deficiency of spleen and stomach qi, deficiency of Qi and blood, deficiency of Qi and Yin, etc. Because of the fact that the disease is not real, it may not be eliminated, or it has been left, or has been transferred. There are many kinds of pathogenic factors, such as qi stagnation, blood stasis, dampness heat, toxin and so on. According to our department, "Jianwei Sanjie Decoction" can play the role of strengthening the body and expelling evil, strengthening the spleen and the stomach. In addition, We also summed up the "spleen invigorating recipe", mainly using medicine and food homologous drugs such as yam, coix seed, Chen PI, and so on, effectively alleviated the malnutrition of most patients due to postoperative nausea, the common electronic moxibustion at Zusanli, the Shen que, Qi Hai, Guan Yuan and other acupoints can be cultured in the kidney, moxibustion at Zusanli, Zhong Wan and inside. Such points can Qi and stomach flatulence; for the dialectic of spleen and kidney yang deficiency patients can also choose the umbilical moxibustion therapy, which the spleen and stomach, shengqingjiangzhuo, xingqizhitong; Pinellas powder Shenque Jiangni vomiting etc..

3. Liver Cancer

Keratectomy is a complex and dangerous operation. Postoperative complications and mortality are relatively high. After hepatectomy, the patients' symptoms such as insomnia, pain, decrease of liver function and gastrointestinal dysfunction make the quality of life of the patients decrease and the patients recover after the operation for a long time. Therefore, it is particularly important to control the above symptoms early after the operation in order to promote the recovery of liver cancer after resection. First of all, our department used "Yugan Sanjie Decoction" and cut Spleen Qi, can Shugan Lidan therapy after surgery, Qi and blood deficiency, liver stagnation and spleen deficiency symptoms has very good curative effect. In view of insomnia, we use the Wang bu liu xing ear point pressure bean, which has the function of nourishing heart, invigorating the spleen, benefiting the kidney and regulating the liver. The Chinese herbal medicine foot bath is used to process fine powder and flush the foam feet with hot water, so that the effective ingredients can penetrate into the skin by the help of heat and be sucked into the blood circulation system to reach the blood circulation system. God, to improve the physique; also can use the “Huayuzhitong” powder topical pain Sanjie analgesic; for abdominal distension constipation, can use traditional Chinese medicine Dachengqi Decoction "rectal instillation laxative.

4.Breast cancer

Breast cancer is the most common malignancy in women, and its incidence has been on the rise in the past 20~30 years. Improved clinical routine radical mastectomy for breast cancer are needed to axillary lymph node dissection in breast cancer postoperative ipsilateral upper limb lymphedema become the most common complication of breast cancer surgery. In view of this complication, we formulate rehabilitation combined with traditional Chinese medicine acupuncture and acupoint massage therapy can restore limb function of patients, reduce the incidence of postoperative disability rate, improve the quality of life. In addition, microwave therapy is used to relieve pain and local swelling after chest pain.

Rehabilitation treatment period after breast cancer surgery, in order to righting evil spirits as the treatment principle, emphasis on stage medication, syndrome differentiation and emotional adjustment, and throughout. Emotion is an important factor to affect the quality of life of patients after radical resection of breast cancer and metastasis recurrence. The patients with breast cancer have more anxiety, fear, depression and pessimism, which are very bad for the rehabilitation of the disease. We use traditional Chinese medicine music therapy in clinical. The main intervention method is based on the different physique of the patients of Chinese medicine. Exquisite style of music. The clinical observation of traditional Chinese medicine and music therapy can significantly reduce breast cancer after surgery in patients with self rating Anxiety Scale and self rating depression scale score.

 

The ultimate goal of postoperative rehabilitation is to maximize the quality of life of patients and make them have the most ideal social function. Every tumor patient in the stage of rehabilitation should not think of himself as a patient and "raise disease" at home all day. It should change the role in time, return to work as soon as possible, actively participate in some social activities, reintegrate into the family and society, and realize the value of his life. Through clinical observation, the tumor patients can improve the immune function of the body and control the recurrence of the tumor to the maximum extent, as long as they keep good mood, tranquil and living, and adjust the balance between yin and Yang, as long as they are guided by the theory of traditional Chinese medicine. 

 

肿瘤术后患者的中西医康复指导
 
        肿瘤患者在经过手术治疗后,会有较长时间的康复阶段,肿瘤康复就是调动医、患、家庭及社会的力量,综合运用各种技术措施,帮助患者最大程度度地恢复身体和心理健康,并主动获得社会职业能力。肿瘤康复包含内容较广,包括心理、药物、运动、饮食及生活等多方面的综合干预。
       (一)肺癌
        近年来肺癌发病率呈飞速上升的趋势,人们对肺癌的警惕性也越来越高。随着肺癌筛查技术越来越先进,更多的早期肺癌患者得以确诊并接受手术治疗。肺切除术后持续咳嗽及呼吸功能下降是肺癌术后常见的临床症状。
        1.持续性咳嗽的发生可能与支气管牵拉、淋巴结清扫、膈肌抬高、胃食管反流等因素有关。虽然术后的咳嗽可以帮助排痰,清除气道分泌物,但频繁剧烈的咳嗽对患者的生活质量造成严重影响。西医在治疗此类咳嗽时,通常采用病因性治疗、镇咳治疗及祛痰治疗,然而这些治疗作用靶点单一,临床疗效有限。而以辨证施治为特点的中医疗法对肺癌术后咳嗽具有重要意义。我科在长期临床实践中总结出“康肺散结汤”,再根据患者辩证分型适当加减化裁,在治疗肺癌手术并发症方面取得了不错的疗效。对于肺癌顽固性咳嗽患者,还可配合“止咳平喘散”穴位敷贴、及中医食疗方,均可以不同程度缓解咳嗽症状。
        2.呼吸功能是决定肺癌患者术后生活质量的重要因素。由于手术切除部分肺组织,减少了肺有效通气面积,破坏了肺力学和肺通气功能,使患者运动耐量下降。目前国内外关于肺癌术后肺康复治疗的临床研究较少,且样本量较小,在国内并未得到普及。而中医在改善呼吸功能方面,内外治法结合,疗效突出。通常我们可取中医八段锦锻炼、配合针刺疗法(取穴为双侧尺泽、内关、足三里),均对患者肺功能改善有明显效果。
        (二)胃癌
        手术是目前根治胃癌首选的治疗方法,胃癌术后除感染、出血等普通并发症外,还会出现排空障碍、胆汁反流、倾倒综合征、胆胰疾患和远期营养不良等,往往给患者带来很多的痛苦和烦恼。引起这些症状的原因是术中切断迷走神经干,导致肝、胆、胰、肠等脏器分泌功能降低,胆囊收缩功能下降,排空障碍,肠道内各种消化液不足,各种消化酶缺乏,再加上肠蠕动减弱,使蛋白质、脂肪消化吸收不全。因此胃癌手术后饮食调护至关重要。首先选择易消化、高蛋白、低糖、适量脂肪,坚持少量、多餐避免胃肠蓄积过多,以免引起消化不良,干稀分开。进食温和性食物的原则,做到合理搭配,营养均衡,避免刺激性、过敏性、高渗性食品以及过冷过热产气食物。中医认为胃癌术后以虚证为多见, 多表现为脾胃气虚、气血双亏、气阴两虚等。又因虚夹实或病邪却未必除尽, 或有残留, 或已转移, 多夹杂气滞血瘀, 湿热邪毒等实邪。我科据此自拟“健胃散结汤”,可起到扶正驱邪,健脾和胃之功效。另外,我科还总结出了“健脾食疗方”,主要选用药食同源药物如山药、薏苡仁、陈皮等,有效缓解了多数患者因术后纳差导致的营养不良;常用电子艾灸足三里、神阙、气海、关元等穴位可培肾固本,艾灸足三里、中脘、内关等穴位可理气除胀和胃;对于辩证为脾肾阳虚的病人还可选用脐灸疗法,功可健脾和胃,升清降浊,行气止痛;半夏粉外敷神阙穴降逆止呕等。
       (三)肝癌
        肝癌切除术是复杂与危险的手术,术后并发症和死亡率均较高。肝癌切除术后患者所表现失眠、术口疼痛、肝功能降低、胃肠功能障碍等症状,使患者生活质量下降,长期影响患者术后恢复,因此,如何在术后早期控制上述症状以促进肝癌切除术后康复尤为重要。首先,我科常用方“愈肝散结汤”加减化裁可健脾益气、疏肝利胆,治疗手术后气血虚弱、肝郁脾虚等症状有很好疗效。针对失眠,我们采用王不留行子耳穴压豆,具有养心安神、健脾益肾、疏肝理气作用;中药足浴一号方加工细粉,用热水冲泡泡脚,使有效成分在热力的帮助下,渗透进皮肤,被足部毛细血管吸收,进入血液循环系统,达到安神、改善体质作用;另外还可使用“化瘀止痛散”外敷疼痛部位止痛散结;针对腹胀便结,可使用中药“承气汤”直肠滴入法通腑降浊。
       (四)乳腺癌
        乳腺癌是妇女最常见的恶性肿瘤,其发病率在近20~30年呈持续上升趋势。临床常规进行的乳腺癌改良根治手术大多需要同时行腋窝淋巴结清扫,导致乳腺癌术后同侧上肢淋巴水肿成为乳腺癌手术最常见并发症之一。针对此项并发症,我们制定了康复操配合中医针刺、穴位按摩疗法,可恢复患者患肢功能,降低术后残障率发生,提高生存质量。另外,针对术后胸壁疼痛、局部肿胀,采用微波疗法,可消肿止痛、通络。
        乳腺癌术后康复期的中医治疗, 以扶正驱邪为治疗原则, 强调分期用药、辨证论治和情志调摄, 且贯穿始终。情志乃是影响乳腺癌根治术后患者生活质量和是否转移复发的重要因素。乳腺癌患者术后多焦虑、恐惧、压抑和悲观, 对疾病的康复十分不利,我们在临床上采用中医音乐疗法,其干预方式主要是根据患者中医不同体质,予以相制约的音乐类型,如偏阳质的人选用“阴柔”一类的音乐,即轻柔、婉约、细腻的音乐风格。临床观察,中医音乐疗法可以显著降低乳腺癌手术后患者焦虑自评量表及抑郁自评量表评分。
 
        肿瘤术后康复的最终目标就是最大程度地提高患者的生存质量,并使其具有最理想的社会功能。处在康复阶段的每一个肿瘤患者,都不应该把自己看作病人而整天在家“养病”,要及时转变角色,尽早回到工作岗位,积极参加一些社会活动,重新融入家庭和社会,实现自己的人生价值。通过临床观察,肿瘤病人只要以中医养生理论为指导,保持良好的情绪,恬淡七情六欲,调摄饮食起居,调整阴阳平衡,就可以提高肌体的免疫功能,最大程度地控制肿瘤的复发,正如《内经》所云,“恬淡虚无,真气从之,精神内守,病安从来”。

 

 

主攻方向 Main attack direction

科室形象 Oncology Image