恶性肿瘤化疗患者恶心和呕吐的影响因素及护理措施

Influencing factors and nursing measures of nausea and vomiting in patients with malignant tumor undergoing chemotherapy

目的:探讨恶性肿瘤化疗患者恶心和呕吐的影响因素及护理措施。方法:2017年1月至2018年4月,对北京大学深圳医院收治的200例恶性肿瘤患者进行临床对照试验研究,按照GP(吉西他滨+顺铂)、AT(吡柔比星+多西他赛或紫杉醇)、AC(吡柔比星+环磷酰胺)、mFOLFOX(奥沙利铂+亚叶酸钙+5-氟尿嘧啶)、TC(多西他赛或紫杉醇+环磷酰胺)等5种化疗方案进行分组,比较各组预期性呕吐评分、抑郁自评量表(SDS)、焦虑自评量表(SAS)、体力状况评分(KPS)、肿瘤患者营养状况评估量表、患者疼痛程度采集表(VRS法)评分,再对其综合分析得出结果并结合实际情况探讨护理措施。结果:患者恶心呕吐发生例数中肿瘤转移者显著高于肿瘤没有转移者,肠癌、肺癌者显著高于其余肿瘤类别者,有腹胀感者显著高于没有腹胀感者,KPS评分低者显著高于KPS评分高者;恶心呕吐发生例数中化疗方案选用AC者显著高于其他化疗方案者,化疗周期越多、患者恶心呕吐频率显著提高,差异均有统计学意义(均P<0.05);腹胀感(OR=4.527),化疗周期(OR=4.306),化疗方案(OR=3.633),肿瘤类别(OR=3.896),体力情况(OR=2.535),肿瘤是否转移(OR=2.054)与恶心呕吐发生显著相关(均P<0.05)。结论:恶性肿瘤患者出现恶心、呕吐与化疗药物对胃肠道上皮细胞的损伤有关,针对此现象应对其进行常规护理干预,从患者对疾病的认知、心理素质、饮食行为习惯、居住环境、呕吐等方面干预。

Objective To explore the influencing factors and nursing measures of nausea and vomiting in patients with malignant tumor undergoing chemotherapy.Methods From January 2017 to April 2018,a controlled clinical trial was conducted on 200 patients with malignant tumor admitted to Peking University Shenzhen Hospital.Groups were divided according to 5 chemotherapy regimens:GP(gemcitabine+cisplatin),AT(pirubicin+docetaxel or paclitaxel),AC(pirubicin+cyclophosphamide),mFOLFOX(oxaliplatin+calcium folinate+5-fluorouracil)and TC(docetaxel or paclitaxel+cyclophosphamide).The scores of expected vomiting,depression self-rating scale(SDS),anxiety self-rating scale(SAS),physical strength rating scale(KPS),nutrition assessment scale for tumor patients,and pain degree acquisition scale(VRS)were compared in each group,and then the results were obtained through comprehensive analysis and nursing measures were discussed based on the actual situation.Results In the number of patients with nausea and vomiting,tumor metastasis was significantly higher than that without metastasis,colorectal cancer and lung cancer were significantly higher than that of other tumor types,abdominal distension was significantly higher than that of no distension,and low KPS score was significantly higher than that of high KPS score.Among the cases of nausea and vomiting,patients with AC chemotherapy were significantly higher than those with other chemotherapy regimens,and the frequency of nausea and vomiting in patients with more chemotherapy cycles was significantly increased,with statistically significant differences(P<0.05).To nausea and vomiting occurs in patients with malignant tumor chemotherapy as the dependent variable,to whether tumor type,tumor metastasis,abdominal distension,physical condition,chemotherapy,chemotherapy cycle as the independent variable,regression equation fitting,their corresponding variables influence as follows:abdominal distension(OR=4.527),cycles of chemotherapy(OR=4.306),chemotherapy regimens(OR=3.633),tumor category(OR=3.896),physical condition(OR=2.535),whether the tumor metastasis(OR=2.054).Conclusions The occurrence of nausea and vomiting in malignant tumor patients is related to the damage of chemotherapy drugs to gastrointestinal epithelial cells.Routine nursing intervention should be carried out for this phenomenon,and intervention should be made from the aspects of patients'cognition,psychological quality,eating habits,living environment and vomiting.