劳拉西泮、苯海拉明、氟哌啶醇联合托烷司琼对比地塞米松联合托烷司琼预防高致吐风险化疗呕吐的疗效

Comparison of Lorazepam,Diphenhydramine,Haloperidol Combined with Tropisetron and Dexamethasone Combined with Tropisetron Efficacy in Preventing Emesis Induced by Highly Emetogenic Chemotherapy

目的探讨劳拉西泮(Ativan)、苯海拉明(Benadryl)和氟哌啶醇(Haldol)的方案(以下简称ABH)联合托烷司琼和地塞米松联合托烷司琼用于高致吐风险化疗[参见2011版多国癌症支持治疗学会(MASCC)止吐指南]后的急性、延迟性呕吐的疗效。方法 104例应用高致吐风险药物单天化疗的患者随机分为ABH组和地塞米松组,两组均在化疗前半小时静脉滴注托烷司琼5mg,ABH组于化疗头4天予以劳拉西泮0.34mg、苯海拉明25mg、氟哌啶醇1.5mg口服,每天3次;地塞米松组于化疗当天予以地塞米松20mg口服,化疗后3天予以地塞米松8mg口服,每天2次。使用MASCC止吐问卷及生活功能指数(呕吐)问卷,了解患者急性及延迟性呕心呕吐控制率及生活质量。结果 ABH组和地塞米松组各入组52名患者。两组恶心、呕吐的控制均良好,急性恶心的控制率ABH组和地塞米松组分别为62%和52%,延迟性恶心情况分别为23%和17%,急性呕吐分别为88%和87%;延迟性呕吐分别为77%和65%,ABH的疗效优于地塞米松,但两者差异无统计学意义,可能与样本量小相关。值得一提的是,在延迟性恶心程度控制方面ABH组优于地塞米松组(2.63 vs.3.69),两组差异有统计学意义(P<0.05)。两组患者的生活质量均受到中度影响,差异无统计学意义,且均未发生严重不良反应。结论劳拉西泮、苯海拉明、氟哌啶醇(ABH)联合5HT-3受体拮抗剂预防高致吐风险化疗后的恶心呕吐有一定疗效,可用于化疗相关恶心呕吐的防治。

Objective To compare the efficacy of lorazepam,diphenhydramine and haloperidol（abbreviation as ABH）combined with Tropisetron therapies in preventing emesis induced by highly emetogenic chemotherapy refer to 2011 edition of MASCC antiemetic guidelines.Methods One hundred and four patients treated with highly emetogenic single day chemotherapy were randomized into ABH and dexamethasone group.Both groups were given tropisetron 5mg intravenous infusion 30 minutes before chemical therapy.Patients in group ABH took lorazepam 0.34 mg,diphenhydramine 25 mg,haloperidol 1.5mg orally thrice a day on the therapy day and three days later.Group dexamethasone was given dexamethasone 20 mg once on the therapy day and 8 mg twice three days later.To study the control rate of acute,delayed nausea and vomiting and the patient＇s living quality,we used the MASCC antiemetic questionnaires and the functional living index-Emesis questionnaire.ResultsFifty two patients were enrolled into each group.Both groups had a good control of acute,delayed nausea and vomiting.The control rates of acute nausea in Group ABH and Group dexamethasone were 62% vs.52%,77% vs.65% in delayed nausea,and 88% vs.87% in acute vomiting,77% vs.65% in delayed vomiting.Group ABH was better than group dexamethasone,but there was no statistical difference between them,which may be caused by the small sample sizes.It＇s worth mentioning that Group ABH was superior to Group dexamethasone in the control of delayed nausea degree（2.63 vs.3.69）（P〈0.05）.The patient＇s living quality was moderately influenced but there was no statistical difference and serious side effects in both groups.ConclusionLorazepam,diphenhydramine and haloperidol（ABH）combined with 5HT-3 receptor antagonist therapy has a good effect in preventing emesis induced by highly emetogenic chemotherapy,with little side effects,and can be to trent chemotherapy induced nausea and vomiting（CINV）.