雷火灸预防伊立替康所致骨髓抑制及迟发性腹泻临床观察

Clinical Observation on the Prevention of Myelosuppression and Delayed Diarrhea Caused by Irinotecan using Thunder Fire Moxibustion

目的:评价雷火灸预防伊立替康(CPT-11)所致白细胞、中性粒细胞减少及迟发性腹泻的临床作用。方法:采用便利抽样,抽取广西中医药大学第一附属医院肿瘤科2017年1月至2018年9月接受含有CPT-11化疗的恶性肿瘤患者120例,由软件产生随机数,随机分为试验组及对照组。试验组于化疗前一日开始给予雷火灸四花穴(膈俞和胆俞)、大肠俞、天枢、中脘、气海、关元穴位,连续应用7天。对照组为空白对照。比较两组患者白细胞、中性粒细胞抑制程度、迟发性腹泻发生情况及严重程度。结果:试验组白细胞I度抑制11例,Ⅱ度2例,Ⅲ度1例,Ⅳ度1例;对照组白细胞I度抑制10例,Ⅱ度抑制10例,Ⅲ度3例,Ⅳ度2例,差异有统计学意义(Z=-2.139,P=0.032)。试验组中性粒细胞I度抑制13例,Ⅱ度3例,Ⅲ度1例,Ⅳ度1例;对照组中性粒细胞Ⅰ度抑制8例,Ⅱ度10例,Ⅲ度5例,Ⅳ度3例,差异有统计学意义(Z=-2.190,P=0.029)。试验组患者8例发生迟发性腹泻,发生率为15.7%,对照组患者16例发生迟发性腹泻,发生率为29.6%,两组差异有统计学意义(Z=-1.977,P=0.048)。结论:雷火灸四花穴、大肠俞、天枢、中脘、气海、关元穴位对CPT-11导致的白细胞、中性粒细胞抑制程度及迟发性腹泻有良好的预防作用,可以提高CPT-11临床使用的安全性。

Objective:To evaluate the clinical effect of thunder fire moxibustion on the prevention of leucocytopenia and neutropenia and delayed diarrhea caused by irinotecan(CPT-11).Methods:A total of 120 patients with malignant tumors receiving CPT-11 chemotherapy in Oncology Department,the First Affiliated Hospital of Guangxi University of Chinese Medicine from January,2017 to September,2018 were selected by convenient sampling.Random numbers were generated by the software and the patients were randomly divided into the experimental group and the control group.The experimental group began to give thunder fire moxibustion on sihua acupoints(geyu and danshu),daochangshu,tianshu,zhongwan,qihai and guanyuan acupoints in the day before chemotherapy,and for 7 consecutive days.The control group was blank.The degree of leukocyte and neutrophil inhibition,the incidence and severity of myelosuppression and delayed diarrhea were compared between the two groups.Results:For leukocyte inhibition,there were 11 cases of grade I inhibition,2 cases of grade II inhibition,1 case of grade III inhibition and 1 case of grade IV inhibition in the experimental group,and there were 10 cases of grade I inhibition,10 cases of grade II inhibition,3 cases of grade III inhibition,and 2 cases of grade IV inhibition in the control group,with statistically significant differences(Z=-2.139,P=0.032).For neutrophil inhibition,there were 13 cases of grade I,3 cases of grade II,1 case of grade III,and 1 case of grade IV in the experimental group,and there were 8 cases of grade I neutrophil inhibition,10 cases of grade II neutrophil inhibition,5 cases of grade III neutrophil inhibition,and 3 cases of grade IV neutrophil inhibition in the control group,with statistically significant differences(Z=-2.190,P=0.029).The incidence of delayed diarrhea was 15.7%with 8 patients in the experimental group and 29.6%in 16 patients in the control group.The difference between the two groups was statistically significant(Z=-1.977,P=0.048).Conclusion:Thunder fire moxibustion at sihua point,daoshu,tianshu,zhongwan,qihai and guanyuan points has a good preventive effect on the inhibition degree of leucocytopenia and neutropenia and delayed diarrhea caused by CPT-11,and can improve the clinical safety of CPT-11.