腹针联合止吐剂防治化疗相关性恶心呕吐自身对照研究

Clinical Observation on Abdominal Acupuncture Combined with Antiemetic Agents in Preventing and Treating Chemotherapy-Induced Nausea and Vomiting:A Crossover Study

目的比较腹针联合止吐剂和单纯止吐剂防治化疗相关性恶心呕吐的疗效差别。方法采用自身交叉对照方法,将40例患者随机分为AB和BA两组,每组20例。AB组在研究阶段的第一化疗周期先接受腹针联合盐酸托烷司琼、甲氧氯普胺治疗,间隔14~28天后,下一周期单用盐酸托烷司琼、甲氧氯普胺;BA组顺序与之相反。将AB组、BA组中采用腹针联合西药治疗者在统计疗效时统称为腹针组(A组),单纯西药治疗者统称为对照组(B组)。比较A组、B组患者化疗期间恶心呕吐的程度,并判定临床疗效及达标情况。同时记录生活质量评分、化疗相关的其他不良反应、化疗前后血常规、肝肾功等结果。结果A、B两组急性恶心、呕吐(化疗24h内)有效率差异无统计学意义(A组:92.5%,B组90.0%,P>0.05);对于延迟性恶心的防治,化疗第3~6天,A组有效率(分别为82.5%、75.0%、90.0%、95.0%)高于B组(分别为60.0%、35.0%、62.0%、72.5%,P<0.05);对于延迟性呕吐的防治,化疗第3~5天,A组有效率(分别为87.5%、80.0%、95.0%)亦优于B组(分别为67.5%、52.5%、75.0%,P<0.05)。A组便秘、腹胀发生率(分别为7.5%、5.0%)低于B组(分别为22.5%、20.0%,P<0.05),A组生活质量评分[(52.6±1.0)分]亦优于B组[(52.1±1.3)分,P<0.05]。结论腹针疗法联合盐酸托烷司琼、甲氧氯普胺可有效缓解化疗相关性恶心呕吐,尤其是在延迟性恶心呕吐方面优势更为显著;腹针可明显改善患者化疗期间出现的腹胀、便秘等不良反应。

Objective To compare the effectiveness of abdominal acupuncture combined with antiemetic agents versus antiemetic agents in preventing and treating chemotherapy-induced nausea and vomiting（CINV）.Methods A self-crossover study was conducted,40 patients were randomly assigned to group AB and group BA,20 cases in each group.Patients in group AB received abdominal acupuncture combined with tropisetron and metoclopramide during the first cycle,and then received tropisetron and metoclopramide only during the next cycle after 14 to 28 days.Patients in group BA received a contrary schedule.Group A referred to patients who received abdominal acupuncture combined with antiemetic agents,while group B referred to patients who accepted antiemetic agents only during the two periods.We made a record of the degree of CINV to compare the effective rate between the two groups.Quality of life,other adverse reactions induced by chemotherapy,blood routine examination,liver and kidney function before and after the chemotherapy were also observed.Results The effective rates of both acutenausea and vomiting（within 24 h）were 95.0%in group A,and 92.5%in group B,without significant difference between the two groups（P〈0.05）.In the 3 th to 6 th day of the chemotherapy,the effective rates of delayed nausea in group A were 82.5%,75.0%,90.0% and 95.0%,while the rates in group B were 60.0%,35.0%,62.0% and 72.5%,respectively.All these differences were statistically significant between the two groups（P〉0.05）.In the 3 th to 5 th day of the chemotherapy,the effective rates of delayed vomiting in group A were 87.5%,80.0% and 95.0%,while the rates in group B were 67.5%,52.5% and 75.0%,with significant differences between the two groups（P〈0.05）.The incidences of constipation and abdominal distension in group A were 7.5% and 5.0%,which were lower than that of group B（22.5% and 20.0%,P〈0.05）.The score of quality of life in group A（52.6±1.0）was also significantly improved than that of group B（52.1±1.3,P〈0.05）.Conclusions Abdominal acupuncture combined with tropisetron and metoclopramide can effectively prevent CINV,especially in terms of the delayed CINV.Besides,abdominal acupuncture can also alleviate other adverse reactions induced by chemotherapy,such as constipation and abdominal distension,and improve the quality of life of cancer patients.