经皮电刺激对胃癌患者化疗后恶心呕吐的影响

Transcuataneous Electrical Nerve Stimulation Alleviates Chemotherapy-induced Nausea and Vomiting in Gastric Cancer Patients

目的观察经皮电刺激(transcuataneous electrical nerve stimulation,TENS)对胃癌患者化疗后恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)的影响,并探讨恶心呕吐相关生物活性物质五羟色胺(5-hydroxytryptamine,5-HT)在其中的作用。方法本研究纳入94例胃癌化疗患者,所有患者为胃癌初治病例,采用随机数字法分为3组,分别为多拉司琼干预组(DOLA组,n=31)、经皮电刺激联用多拉司琼治疗组(TENS+DOLA组,n=32)和单纯经皮电刺激组(TENS组,n=31)。其中,使用多拉司琼静脉注射的两组中,多拉司琼剂量为100 mg/d;TENS刺激方法为同时刺激双侧足三里、双侧内关和中脘等5处穴位,刺激时间为30 min/d,频率为2/100 Hz疏密波,电流强度为8~10 mA,以上治疗从化疗当天开始,持续至化疗后第六天。结果DOLA组治疗CINV有效率61.3%,TENS+DOLA组治疗CINV总有效率81.3%,而单纯TENS治疗恶心呕吐有效率为77.4%,3组相比无统计学差异(P>0.05);在化疗后2~6 d使用TENS刺激的两组患者血浆中5-HT含量明显降低(P<0.001)。结论 TENS刺激可缓解胃癌患者化疗后恶心呕吐的发生,其机制可能与降低血浆中5-HT水平有关。

Objective To observe the influence of transcuataneous electrical nerve stimulation（TENS）for chemotherapy-induced nausea and vomiting（CINV）in patients with gastric cancer,and explore the role of vomiting-associated bioactive substance 5-hydroxytryptamine（5-HT）in the process.Methods In this investigation,94 patients with gastric cancer were assigned into three groups by random number table,including dolasetron group（DOLA,n=31）,TENS＋DOLA group（n=32）and TENS group（n=31）.The patients of DOLA and TENS＋DOLA groups were administered with 100 mg dolasetron intravenously per day.For the TENS＋DOLA and TENS groups,the five acupoints of bilateral Neiguan and Zusanli,Zhongwan and such were stimulated for 30 min/d,the electricity frequency was 2/100 Hz of dilatational wave,and the current intensity ranged from8-10 mA.The TENS stimulation started at the day of chemotherapy,and ended at the sixth day after the chemotherapy.Results The CINV effective rate in DOLA group was 61.3%,the effective rate of CINV in TENS＋DOLA group was 81.3%,and 77.4%in TENS group.No difference were found in three groups（P0.05）.The plasmic 5-HT concentration reduced in both DOLA＋TENS group and TENS group in 2-6 days after the chemotherapy（P0.001）.Conclusion TENS can alleviate the incidence of CINV in patients with gastric cancer,and the potential mechanism may associate with the reduction of plasmic 5-HT level.