中医辨证针刺治疗不同证型患者化疗所致恶心呕吐临床研究

Clinical Study on TCM Acupuncture Treatment of Chemotherapy-Induced Nausea and Vomiting Patients with Different Syndromes

目的:根据中医辨证,观察在实证、虚证患者中,针刺对预防含顺铂方案化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)的疗效。方法:共171例晚期癌症患者入组,均采用含顺铂方案联合化疗。其中实证87例,虚证84例。在实证患者中,试验组44例,对照组43例;在虚证患者中,试验组42例,对照组42例。所有试验组患者在顺铂前30 min应用托烷司琼5 mg静脉滴注,同时配合针刺足三里、内关、中脘及其他穴位;所有对照组患者仅在顺铂前30min应用托烷司琼5mg静脉滴注。比较各证型患者恶心呕吐的发生率、呕吐的严重程度及持续时间。结果:在实证患者中,试验组与对照组轻中度(Ⅰ-Ⅱ度)恶心呕吐的发生率分别为54.54%和74.42%(P<0.05),且重度(Ⅲ-Ⅳ度)恶心呕吐发生率分别为15.91%和25.58%(P<0.05);在虚证患者中,试验组和对照组轻中度恶心呕吐的发生率分别为54.76%和64.29%(P<0.05)。在实证患者中,试验组和对照组发生轻中度呕吐和重度呕吐的情况比较,差异有统计学意义(P<0.05);在虚证患者中,试验组和对照组仅在轻中度呕吐的发生率上存在差异,而重度呕吐的发生率则无统计学意义。实证患者中,试验组恶心呕吐的持续时间为(3.88±0.83)d,显著短于对照组(4.31±0.96)d,两组比较,差异有统计学意义(P<0.05);而在虚证患者中,试验组恶心呕吐的持续时间为(4.82±0.93)d,对照组为(5.03±1.05)d,两组比较,差异无统计学意义(P>0.05);且两个试验组中,实证患者的持续时间均短于虚证患者。结论:中医辨证针刺可以降低实证患者含顺铂方案化疗后CINV的发生率,降低呕吐的严重程度并缩短持续时间。

Objective： To observe the efficacy of acupuncture in the prevention of chemotherapy-induced nausea and vomiting（ CINV） with cisplatin regimen in the deficiency and excess syndrome according to the TCM syndrome differentiation. Methods： A total of 171 cases of advanced cancer patients,using cisplatin combined chemotherapy. 87 cases of excess syndrome,84 cases of deficiency syndrome. In excess syndrome patients,44 cases of test group and 43 cases in control group; In deficiency syndrome patients,42 cases in test group and 42 cases in the control group. All patients in the test group before cisplatin 30 minutes of application of tropisetron intravenous infusion of 5mg combined with acupuncture at Zusanli,Neiguan,Zhongwan and other acupoints; all the patients in the control group only in 30 minutes before the application of cisplatin 5mg tropisetron intravenous drip. Results： In excess syndrome patients,the test group of mild to moderate and severe vomiting rate decreased compared with the control group（ mild to moderate 1-2 grade,54. 54% vs 74. 42%,P〈 0. 05; severe 3-4 grade,15. 91% vs 25. 58%,P = 0. 032 〈0. 05）. In the asthenia syndrome patient,there was still a difference in the incidence of mild and moderate nausea and vomiting between the test group 54. 76% and control group 64. 29% respectively（ P = 0. 049〈 0. 05）. In excess syndrome patients,nausea and vomiting in test group,the duration was shorter than the control group（ 3. 88 ± 0. 83 days vs 4. 31 ± 0. 96 days,P 〈0. 05）; in the patients with deficiency syndrome,the duration of nausea and vomiting in the test group was（ 4. 82 ± 0. 93） days,and the control group was（ 5. 03 ± 1. 05） days,the difference between the two groups was not statistically significant（ P〉 0. 05）; And in the two test groups,the duration of excess syndrome patients was shorter than patients with Qi deficiency. Conclusion： The syndrome differentiation and treatment of TCM for acupuncture can reduce the incidence of CINV in excess syndrome patients with cisplatin regimen chemotherapy,reduce the severity of vomiting and shorten the duration.