腫瘤化療所致惡心嘔吐現狀調查_《中國循證醫學雜志》

作者：

董爽 ,  于世英

華中科技大學同濟醫學院附屬同濟醫院（武漢 430030）;

關鍵詞：

化療所致惡心嘔吐中度致吐風險化療高度致吐風險化療生活功能調查

DOI：

10.7507/1672-2531.20130122

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目的　調查化療所致惡心嘔吐（chemotherapy-induced nausea and vomiting，CINV）的患者心理預期和發生情況，并評估CINV對患者生活質量的影響，為提高臨床醫生對CINV的認識和重視提供依據。
方法　采用問卷調查的方式，調查華中科技大學同濟醫學院附屬同濟醫院使用中度致吐風險化療（MEC）或高度致吐風險化療（HEC）的患者，并對其進行連續兩周期相同化療方案的隨訪。患者分別于化療開始前、化療第2天和化療第6天，記錄化療期間急性、延遲性惡心嘔吐發生情況、自主止吐用藥和CINV對生活功能的影響，調查結果采用描述性分析和多元線性回歸分析。
結果　本研究共調查344例患者，最終303例患者完成問卷調查。結果顯示：單日化療MEC組急性、延遲性和總的完全緩解率分別為86.1%、76.6%和71.5%，HEC組為84.1%、71.0%和66.7%。多日化療患者分別為93.8%、64.9%和64.9%；第2周期化療前患者關于惡心嘔吐預期值和焦慮值與患者前一周期化療延遲性惡心發生的嚴重程度密切相關；約30%的患者因CINV對生活功能造成負面影響。
結論　在行中度和高度致吐風險化療的患者中，CINV治療現狀仍存在較大問題，尤其是在延遲期反應和惡心癥狀的控制方面。在臨床實踐中需進一步加強對CINV的關注，并提供更加有效的治療措施。

引用本文： 董爽,于世英. 腫瘤化療所致惡心嘔吐現狀調查. 中國循證醫學雜志, 2013, 13(6): 687-691. doi: 10.7507/1672-2531.20130122 復制

1.	Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med, 2008, 358(23): 2482-2494.
2.	Mitchell EP. Gastrointestinal toxicity of chemotherapeutic agents. Semin Oncol, 1992, 19(5): 566-579.
3.	Osoba D, Zee B, Warr D, et al. Effect of postchemotherapy nausea and vomiting on health-related quality of life. Supportive care in cancer, 1997, 5(4): 307-313.
4.	Cohen L, de Moor CA, Eisenberg P, et al. Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer, 2007, 15(5): 497-503.
5.	Wood JM, Chapman K, Eilers J. Tools for assessing nausea, vomiting, and retching. Cancer Nurs, 2011, 34(1): E14-24.
6.	Molassiotis A, Coventry PA, Stricker CT, et al. Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemesis tool. J Pain Symptom Manage, 2007, 34(2): 148-159.
7.	Martin AR, Pearson JD, Cai B, et al. Assessing the impact of chemotherapy-induced nausea and vomiting on patients’ daily lives: a modified version of the Functional Living Index-Emesis (FLIE) with 5-day recall. Support Care Cancer, 2003, 11(8): 522-527.
8.	Smith AR, Repka TL, Weigel BJ. Aprepitant for the control of chemotherapy induced nausea and vomiting in adolescents. Pediatr Blood Cancer, 2005, 45(6): 857-860.
9.	Hesketh PJ, Grunberg SM, Gralla RJ, et al. The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group. J Clin Oncol, 2003, 21(22): 4112-4119.
10.	Jin Y, Sun W, Gu D, et al. Comparative efficacy and safety of palonosetron with the first 5-HT3 receptor antagonists for the chemotherapy-induced nausea and vomiting: a meta-analysis. Eur J Cancer Care (Engl), 2013, 22(1): 41-50.
11.	Lin SJ, Hatoum HT, Buchner D, et al. Impact of 5-HT3 receptor antagonists on chemotherapy-induced nausea and vomiting: a retrospective cohort study. BMC Health Serv Res, 2012, 12(1): 215.
12.	Navari RM. Pharmacological management of chemotherapy-induced nausea and vomiting: focus on recent developments. Drugs, 2009, 69(5): 515-533.
13.	Bloechl-Daum B, Deuson RR, Mavros P, et al. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol, 2006, 24(27): 4472-4478.
14.	NCCN Clinical Practice Guidelines in Oncology version 1, 2013. Antiemesis.National Comprehensive Cancer Network (NCCN) [online]. Available from URL: http://www.nccn.org/professionals/physician_gls/PDF/ antiemesis.pdf, 2013).
15.	Shi J, Wei PK. Professor Wei Pin-kang’s experience in treating chemotherapy induced nausea and vomiting: an analysis of herbal medication. China Journal of Integrated Traditional Medicine and Western Medicine, 2012, 32(4): 556-559, 571.
16.	Pillai AK, Sharma KK, Gupta YK, et al. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer, 2011, 56(2): 234-238.
17.	Qian QH, Yue W, Wang YX, et al. Gingerol inhibits cisplatin-induced vomiting by down regulating 5-hydroxytryptamine, dopamine and substance P expression in minks. Arch Pharm Res, 2009, 32(4): 565-573.
18.	Grunberg S. Patient-centered management of chemotherapy-induced nausea and vomiting. Cancer Control, 2012, 19(2 Suppl): 10-15.
19.	Richardson J, Smith JE, McCall G, et al. Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. Eur J Cancer Care (Engl), 2007, 16(5): 402-412.
20.	朱丹, 呂黃偉, 李曉倩, 等. P6 刺激對術后惡心嘔吐有效性的 Meta 分析. 中國循證醫學雜志, 2010, 10(8): 923-931.
21.	Parfitt A. Acupuncture as an antiemetic treatment. J Altern Complement Med, 1996, 2(1): 167-174; discussion 175-167.
22.	Thompson N. Optimizing treatment outcomes in patients at risk for chemotherapy-induced nausea and vomiting. Clin J Oncol Nurs, 2012, 16(3): 309-313.
23.	So WK, Chan DN, Chan HY, et al. Knowledge and practice among Hong Kong oncology nurses in the management of chemotherapy-induced nausea and vomiting. Eur J Oncol Nurs, 2012.
24.	Salsman JM, Grunberg SM, Beaumont JL, et al. Communicating about chemotherapy-induced nausea and vomiting: a comparison of patient and provider perspectives. J Natl Compr Canc Netw, 2012, 10(2): 149-157.
25.	Radbruch L, Payne S, de Lima L, et al. The Lisbon Challenge: Acknowledging Palliative Care as a Human Right. J Palliat Med, 2013.

1. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med, 2008, 358(23): 2482-2494.
2. Mitchell EP. Gastrointestinal toxicity of chemotherapeutic agents. Semin Oncol, 1992, 19(5): 566-579.
3. Osoba D, Zee B, Warr D, et al. Effect of postchemotherapy nausea and vomiting on health-related quality of life. Supportive care in cancer, 1997, 5(4): 307-313.
4. Cohen L, de Moor CA, Eisenberg P, et al. Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer, 2007, 15(5): 497-503.
5. Wood JM, Chapman K, Eilers J. Tools for assessing nausea, vomiting, and retching. Cancer Nurs, 2011, 34(1): E14-24.
6. Molassiotis A, Coventry PA, Stricker CT, et al. Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemesis tool. J Pain Symptom Manage, 2007, 34(2): 148-159.
7. Martin AR, Pearson JD, Cai B, et al. Assessing the impact of chemotherapy-induced nausea and vomiting on patients’ daily lives: a modified version of the Functional Living Index-Emesis (FLIE) with 5-day recall. Support Care Cancer, 2003, 11(8): 522-527.
8. Smith AR, Repka TL, Weigel BJ. Aprepitant for the control of chemotherapy induced nausea and vomiting in adolescents. Pediatr Blood Cancer, 2005, 45(6): 857-860.
9. Hesketh PJ, Grunberg SM, Gralla RJ, et al. The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin--the Aprepitant Protocol 052 Study Group. J Clin Oncol, 2003, 21(22): 4112-4119.
10. Jin Y, Sun W, Gu D, et al. Comparative efficacy and safety of palonosetron with the first 5-HT3 receptor antagonists for the chemotherapy-induced nausea and vomiting: a meta-analysis. Eur J Cancer Care (Engl), 2013, 22(1): 41-50.
11. Lin SJ, Hatoum HT, Buchner D, et al. Impact of 5-HT3 receptor antagonists on chemotherapy-induced nausea and vomiting: a retrospective cohort study. BMC Health Serv Res, 2012, 12(1): 215.
12. Navari RM. Pharmacological management of chemotherapy-induced nausea and vomiting: focus on recent developments. Drugs, 2009, 69(5): 515-533.
13. Bloechl-Daum B, Deuson RR, Mavros P, et al. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol, 2006, 24(27): 4472-4478.
14. NCCN Clinical Practice Guidelines in Oncology version 1, 2013. Antiemesis.National Comprehensive Cancer Network (NCCN) [online]. Available from URL: http://www.nccn.org/professionals/physician_gls/PDF/ antiemesis.pdf, 2013).
15. Shi J, Wei PK. Professor Wei Pin-kang’s experience in treating chemotherapy induced nausea and vomiting: an analysis of herbal medication. China Journal of Integrated Traditional Medicine and Western Medicine, 2012, 32(4): 556-559, 571.
16. Pillai AK, Sharma KK, Gupta YK, et al. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer, 2011, 56(2): 234-238.
17. Qian QH, Yue W, Wang YX, et al. Gingerol inhibits cisplatin-induced vomiting by down regulating 5-hydroxytryptamine, dopamine and substance P expression in minks. Arch Pharm Res, 2009, 32(4): 565-573.
18. Grunberg S. Patient-centered management of chemotherapy-induced nausea and vomiting. Cancer Control, 2012, 19(2 Suppl): 10-15.
19. Richardson J, Smith JE, McCall G, et al. Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. Eur J Cancer Care (Engl), 2007, 16(5): 402-412.
20. 朱丹, 呂黃偉, 李曉倩, 等. P6 刺激對術后惡心嘔吐有效性的 Meta 分析. 中國循證醫學雜志, 2010, 10(8): 923-931.
21. Parfitt A. Acupuncture as an antiemetic treatment. J Altern Complement Med, 1996, 2(1): 167-174; discussion 175-167.
22. Thompson N. Optimizing treatment outcomes in patients at risk for chemotherapy-induced nausea and vomiting. Clin J Oncol Nurs, 2012, 16(3): 309-313.
23. So WK, Chan DN, Chan HY, et al. Knowledge and practice among Hong Kong oncology nurses in the management of chemotherapy-induced nausea and vomiting. Eur J Oncol Nurs, 2012.
24. Salsman JM, Grunberg SM, Beaumont JL, et al. Communicating about chemotherapy-induced nausea and vomiting: a comparison of patient and provider perspectives. J Natl Compr Canc Netw, 2012, 10(2): 149-157.
25. Radbruch L, Payne S, de Lima L, et al. The Lisbon Challenge: Acknowledging Palliative Care as a Human Right. J Palliat Med, 2013.

《中國循證醫學雜志》

腫瘤化療所致惡心嘔吐現狀調查

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腫瘤化療所致惡心嘔吐現狀調查

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