艾灸联合口服药物改善难治性癌性恶心呕吐的临床观察

Moxibustion Plus Medication Can Relieve Refractory Nausea and Vomiting and Improve Quality of Life of Advanced Cancer Patients Undergoing Chemical Therapy

目的:探讨艾灸联合甲氧氯普胺和氟哌啶醇对晚期癌症患者难治性癌性恶心呕吐(CRNV)的疗效及生活质量的影响。方法:选取确诊为晚期恶性肿瘤伴恶心呕吐的患者266例,按随机序列分为对照组(n=70)、甲氟二联组(n=65)、艾甲二联组(n=63)、艾甲氟三联组(n=68)。对照组予甲氧氯普胺,甲氟二联组予甲氧氯普胺联合氟哌啶醇,艾甲二联组予艾灸联合甲氧氯普胺,艾甲氟三联组予艾灸联合甲氧氯普胺和氟哌啶醇。甲氧氯普胺口服10mg,3次/d,氟哌啶醇口服1mg,2次/d,艾灸穴位选取足三里(双侧)、关元、气海,每次20min,2次/d,均治疗2周。监测患者治疗前后恶心呕吐及干呕指数评价量表(INVR)、汉密尔顿抑郁量表(HAMD)和生活质量量表(FACT-G)评分。结果:与治疗前比较,治疗后各组INVR评分、HAMD评分显著降低(P<0.05)。治疗后,艾甲氟三联组INVR、HAMD评分显著低于对照组、甲氟二联组和艾甲二联组(P<0.05),生活质量总分及情感状况、生理状况评分显著高于对照组、甲氟二联组和艾甲二联组(P<0.05)。结论:艾灸联合甲氧氯普胺和氟哌啶醇对晚期癌症患者CRNV具有明显改善作用,可一定程度上改善抑郁,提高生活质量。

Objective To explore the efficacy of moxibustion combined with medication in the treatment of refractory nausea and vomiting and quality of life（QOL）in advanced cancer patients.Methods A total of 266 advanced cancer patients with nausea and vomiting were randomly assigned to Metoclopramide group（M group,n=70）,Metoclopramide plus Haloperidol group（MH group,n=65）,moxibustion＋ M group（n=63）,and moxibustion＋ MH group（n=68）.Moxibustion was applied to bilateral Zusanli（ST 36）,and Guanyuan（CV 4）,Qihai（CV 6）for 20 min every time,twice a day for 2 weeks.The Rhodes＇ Index of nausea,Vomiting and Retching（INVR）was used for assessing the state of these symptoms in duration,frequency and severity（40 points）,the 24-item Hamilton Depression Rating Scale（HAMD,0-76 points）was employed to measure the patients＇ depression severity,and the Functional Assessment of Cancer Therapy-General（FACT-G,including physical,social/family,emotional,and functional dimensions,27 items,108 points）was adopted to measure the cancer patients＇ QOL.Results Following the treatment,the INVR and HAMD scores were significantly decreased in the M,MH,moxibusion＋M and moxibustion＋MH groups in comparison with their own pretreatment（P〈0.05）and were significantly lower in the moxibustion＋MH group than in the M,MH and moxibustion＋M groups（P〈0.05）.The FACT-G scoring outcomes showed that the scores of physical well-being,emotional well-being,and total score of QOL were significantly higher in the MH,moxibustion＋M and moxibustion＋MH groups than in the M group,and were significantly higher in the moxibustion＋MH group than in the MH and moxibustion＋M groups（P〈0.05）.No significant differences were found between the MH and moxibustion＋M groups in the INVR and HAMD scores,and in the scores of physical well-being,emotional well-being and total score of QOL（P〈0.05）.Conclusion Moxibustion plus Metoclopramide and Haloperidol can relieve refractory nausea and vomiting,and better depression and QOL in advanced cancer patients,being worthy of popularization in clinical practice.