臺灣博碩士論文加值系統

背景與目的：台灣近年癌症發生率以消化道癌症居多，其中以大腸直腸癌奪冠。在癌症患者的臨床治療中，輔助性化學治療(adjuvant chemotherapy)扮演著控制癌細胞復發及延續患者生命的重要角色。而oxaliplatin 是臨床上針對腸胃道癌症，及肺癌、乳癌、卵巢癌患者的化學治療(chemotherapy)中，廣泛使用之第一線處方用藥。但約有90％患者會因使用oxaliplatin而引發急性神經病變，15％-20％會引發慢性期周邊神經病變，影響患者生活品質及功能，並可能因導致患者副作用的不適而需降低化療用藥劑量，或是更改化療用藥，甚至停止化學治療。本實驗的目的，為評估雷射針灸對於減輕癌症患者因接受化療藥物oxaliplatin引發之周邊神經病變而致感覺異常的效果。方法：本研究之受試者招募於中區某醫學中心的大腸直腸外科與癌症特診中心，包含13位接受oxaliplatin藥物治療之消化道癌症術後患者，併發有oxaiplatin誘發周邊神經病變之症狀，Oxaliplatin症狀等級量表(Oxaliplatin specific neuropathy scale, OSNS) 分級為grade I-III。每位受試者於四肢遠端各選取5個穴位點，包括上肢：內關(PC6)、大陵(PC7)、勞宮(PC8)、中冲(P9)、少商(LU11)；下肢：三陰交(SP6)、太谿(KI3)、崑崙(BL60)、湧泉(KI1)、然谷(KI2)。在選取穴位點上每次治療20分鐘，共接受十二次的雷射針灸治療，雷射劑量96J。於治療前、第六次治療後、及第十二次治療後進行評估，評估方法包括：(1)機械感覺閾值(2)疼痛品質評估量表、(3)化療引發周邊神經感覺症狀量表(chemotherapy-induced peripheral neuropathy, CIPN量表)、OSNS量表、(5)受試者主述冷過敏症狀。結果：受試者在接受治療前及接受十二次雷射針灸治療後之機械性感覺閾值、疼痛品質評估量表分數、CIPN量表、Oxaliplatin特異性神經毒性症狀分級量表及冷過敏症狀改善的人數，均顯示有顯著的差異(P＜0.05)。結論：雷射針灸治療對於oxaliplatin誘發的周邊神經感覺異常及其特有的冷過敏症狀，有減輕的效果。

BACKGROUND AND OBJECTIVE: Gastrointestinal (GI) cancer has been the most common cancer in Taiwan especially for colorectal cancer during the past decade. Oxaliplatin is clinically widespread used as the first line chemotherapy for patients with gastrointestinal cancer. However, unfortunately, oxaliplatin-induced peripheral neuropathy (OIPN) occurs in about 90% of patients suffering acute neuropathy with distal paraesthesia and cold-triggered dysesthesia and 15% -20% leading chronic neuropathy with painful sensations. However, there are few studies demonstrating the nonpharmacological neuroprotective strategies on management of OIPN. The purpose of this study is to investigate the effects of laser acupuncture on managements of OIPN in gastrointestinal cancer patients with chemotherapy. Methods: Patients (n=13) with gastrointestinal cancer received oxaliplatin administration were routinely referred from the Department of Oncology and Cancer Center. All of the subjects surffered from OIPN. Low-level laser stimulation (50mW, 60 J) at acupoints of Neiguan (PC6), Daling (PC7), Laogong (PC8), Chongchung (P9), Shao shang (LU11), Sanyinjiao (SP6), Taixi (KI3), Kunlun (BL60), Yongquan (KI1), Rangu (KI2) were conducted for 20 minutes/point for 12 times. Measurements on Von Frey test, Pain Quality Assessment Scale (PQAS), Chemotherapy-induced peripheral neuropathyscale (CINQ), Oxaliplatin-specific neurotoxicity scale (OSNS) were performed before and after 12-session treatments. Results: Significant improvements were found on mechanical threshold, scores of PQAS、CIPN, and cold allodynia symptom after 12-session laser acupuncture in gastrointestinal cancer patients with OIPN. Conclusion: Neuropathic sensory symptoms and neurotoxicity severity in GI cancer patients with OIPN could be controlled and improved by laser acupuncture.

中文摘要 …………………………………………………………Ⅰ
英文摘要 …………………………………………………………Ⅱ
壹、緒論
1. 化學治療對癌症患者的角色與影響 ………………………….1
2. 消化道癌症及其治療 ………………………………………….3
3. Oxaliplatin用於癌症患者
3.1 臨床施用模式 …………………………………………….5
3.2 Oxaliplatin引起的周邊神經病變症狀 …………………7
3.3 Oxaliplatin 導致周邊神經病變之機轉 ………………… 8
4. 復健醫療於癌症領域中的角色 ……………………………… 8
5. 低能雷射治療神經病變及感覺異常 ………………………… 9
5.1 低能雷射促進周邊神經生長 ……………………………10
5.2 低能雷射治療神經病變的效果 …………………………10
5.3 低能雷射對於治療疼痛、冷覺異常及機械性感覺過
敏的效果 …………………………………………………11
6. 針灸治療神經病變的效果 ……………………………………12
7. 雷射針灸治療化療藥引起的周邊神經病變及感覺異
常的可能性 ………………………………………………13
貳、研究目的 ……………………………………………………14
參、實驗方法
1. 受試者選取 …………………………………………………15
2. 評估工具及方法 ……………………………………………16
3. 實驗設計 ……………………………………………………17
4. 穴位選取 ……………………………………………………17
5. 雷射治療劑量 ………………………………………………18
6. 統計方法 ……………………………………………………18
肆、實驗結果
1. 機械感覺閾值 ……………………………………………… 19
2. 疼痛品質評估量表 …………………………………………19
3. 化療影響症狀及功能影響評估量表 ………………………20
4. Oxaliplatin 特異性神經毒性症狀分級量表 ………………20
5. 患者主述的冷敏感 …………………………………………20
6. 患者主述的Lhermitte sign ……………………………….21
伍、討論 …………………………………………………………21
陸、參考文獻 ……………………………………………………28
柒、圖表及附件 …….……………………………………………38

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