降逆止吐膏方贴脐+耳穴按压联合西药治疗顺铂所致延迟性呕吐随机均衡配对、自身交叉对照研究

Jiangni Antiemetic Square Paste Paste Umbilical + Auricular Acupressure Combined with Western Medicine Delayed Emesis Induced by Cisplatin Balanced Random Pairing,Crossover Controlled Study

[目的]观察降逆止吐膏方贴脐＋耳穴按压联合西药治疗顺铂所致延迟性呕吐疗效。[方法]使用随机均衡配对、自身交叉对照设计方法,将60例住院患者按纳入先后顺序和病情等配对等分为两组,每组30例。西药法化疗前0.5h,格拉司琼3mg,1次/d,静滴;地塞米松5mg,1次/d,静滴;顺铂用药结束后继续使用2d;中西医结合法应用降逆止吐方膏剂贴脐加耳穴按压,降逆止吐方（半夏、茯苓、泽泻、白豆蔻）均以1：1比例研成粉,以生姜汁、蜂蜜调如膏状备用;用药前清洁肚脐,取透皮吸收促进剂冰片少许掺入软膏中搅匀,进行贴脐,医用薄膜固定;每穴每次约5g,贴脐中药更换1次/d;耳穴按压主穴：胃、十二指肠、大肠、交感、神门、皮质下;配穴：肝气犯胃者配肝、胆;脾胃虚弱配脾,用75%的酒精消毒耳廓,以王不留行籽按压在选取的相应穴位上,以胶布固定,用拇、食指相对按压王不留行籽,以患者感到酸、胀、痛,直至耳廓发红发热为宜,嘱患者自行按压,每次每穴3∽5min,5∽6次/d,每3d两耳交替轮换;上述2种方法从化疗前1d共同使用,顺铂用药结束后继续使用2d。西药治疗同西药法。连续治疗5d为1疗程。观测恶心呕吐控制率、食欲改善率、不良反应。连续治疗2疗程,判定疗效。[结果]中西医结合法第1∽4d恶心呕吐控制率分别为90.00%、83.30%、73.30%、61.70%,食欲改善率分别为88.30%、81.70%、71.70%、60.00%,第5∽6d时恶心呕吐控制率分别为66.70%、70.00%,食欲改善率分别为65.00%、68.30%;西药法第1∽4d恶心呕吐控制率分别为85.00%、73.30%、61.70%、48.30%,食欲改善率分别为83.30%、71.70%、60.00%、46.70%,第5∽6d时恶心呕吐控制率分别为50.00%、53.30%,食欲改善率分别为48.30%、51.70%;中西医结合法第5∽6d恶心呕吐控制率及食欲改善率优于西药法（P〈0.05）。常见不良反应为头痛、眩晕、腹胀、便秘,治疗组便秘发生率低（P〈0.05）。[结论]降逆止吐膏方贴脐＋耳穴按压联合西药治疗顺铂所致延迟性呕吐效果显著,值得推广。

[ Objective ] Jiangni antiemetic square paste paste umbilical ＋ auricular acupressure combined with western medicine delayed emesis induced by cisplatin efficacy. [ Methods ] Using random balanced pair, crossover control design methods, the 60 cases of hospitalized patients were enrolled in the study when the disease such as sequencing and paired divided into two groups of 30 cases. Western France before chemotherapy 0.Sh, granisetron 3mg, 1 times / d, intravenously; dexamethasone 5mg, 1 times / d, intravenously; after cisplatin administration to continue to use 2d. Integrative Application Jiangni antiemetic square paste paste umbilical plus auricular acupressure, Jiangni antiemetie side （ Banxia, Fuling, Zexie, Baidoukou ） are in the ratio of1： 1 research into powder, with ginger, honey tone If the paste standby; medication before cleaning the navel, take a little borneol penetration enhancers incorporated ointment, stir, be affixed to the navel, medical film fixed; Meixue each about 5g, stickers umbilical medicine to replace 1 / d; ear press the main point：the stomach, duodenum, colon, sympathetic, God the door, subcortical; distribution Point： Fan Wei qi with liver, gallbladder; spleen and stomach with the spleen, with 75 % alcohol disinfection ear to the king not pressing the left line on the selected seed points corresponding to tape fixed, with the thumb and forefinger pressed Vaccaria relatively seeds to patients feel acid, swelling, pain, redness, fever until the ear is appropriate, ask the patient self- pressed, every time per hole 3 -- 5min, 5 - 6 times / d, 3d ears alternately every rotation; these two methods commonly used l d from before chemotherapy, after cisplatin administration to continue to use 2d; western medicine with western medicine method. 5d is a continuous course of treatment. Observing control rate of nausea and vomiting, appetite improved rate of adverse reactions. 2 courses of continuous treatment, to determine efficacy. [ Results ] Integrative Medicine Act 1 ~ 4d control of nausea and vomiting rates were 90.00%, 83.30%, 73.30%, 61.70%, appetite improved rates were 88.30%, 81.70%, 71.70%, 60.00%, 5 to 6d the control of nausea and vomiting rates were 66.70%, 70.00%, 65.00% improvement rate appetite, 68.30% respectively; western Act 1 -- 4d control of nausea and vomiting rates were 85.00%, 73.30%, 61.70%, 48.30%, appetite improved rates were 83.30%, 71.70%, 60.00%, 46.70%, for the first 5 -6d control of nausea and vomiting rates were 50.00%, 53.30%, respectively, appetite improved rate of 48.30%, 51.70% respectively; Integrative Medicine Act 5 - 6d nausea and vomiting, and appetite control rate improvement rate than western France （ P〈0.05 ） . Common adverse reactions are headache, dizziness, bloating, constipation, low incidence of constipation treatment group （P〈0.05）. [ Conclusion ] Jiangni antiemetic square paste paste umbilical ＋ auricular acupressure combined with western medicine delayed emesis induced by cisplatin effect is significant, it is worth promoting.