小半夏汤联合穴位针刺治疗乳腺癌术后化疗相关性恶心呕吐的临床研究

Clinical study of Xiaobanxia decoction combined with acupuncture at acupoint on the treatment of chemotherapy-induced nausea and vomiting after breast cancer surgery

目的评价小半夏汤联合穴位针刺防治乳腺癌术后化疗相关性恶心呕吐(CINV)的临床疗效。方法选取2018年1月至2020年12月中国人民解放军总医院第一医学中心收治的192例乳腺癌术后行多柔比星+环磷酰胺/表柔比星+环磷酰胺方案化疗患者,根据随机数字表法将其分为对照组、中药组、针药组,各64例。对照组予格拉司琼+地塞米松静脉滴注治疗,中药组在对照组治疗基础上配合小半夏汤口服治疗,针药组在中药组基础上联合针刺治疗。比较3组急性期(第1天)、延迟期(第2~5天)和全程(第1~5天)恶心、呕吐程度,恶心呕吐完全控制率及不良反应发生情况。结果急性期、延迟期以及全程,针药组、中药组恶心、呕吐程度均明显轻于对照组,且针药组均明显轻于中药组(均P <0.05)。针药组、中药组、对照组急性期恶心呕吐完全控制率分别为41.3%(26/63)、17.2%(11/64)、0,延迟期恶心呕吐完全控制率分别为44.4%(28/63)、34.4%(22/64)、10.9%(7/64),全程恶心呕吐完全控制率分别为31.7%(20/63)、15.6%(10/64)、7.8%(5/64),差异均有统计学意义(均P <0.05)。针药组患者不良反应发生率低于中药组和对照组,差异有统计学意义(χ^(2)=8.203,P=0.017)。结论乳腺癌术后患者化疗前、中、后规范化全程管理可有效减少CINV的发生,中医药治疗作为CINV标准治疗方案的补充治疗,增加疗效的同时可降低不良反应发生率。

Objective To evaluate the clinical efficacy of Xiaobanxia decoction combined with acupuncture at acupoint on prevention and treatment of chemotherapy-induced nausea and vomiting(CINV)after breast cancer surgery.Methods From January 2018 to December 2020,192 patients undergoing doxorubicin+cyclophamide/epirubicin+cyclophamide chemotherapeutic regimen after breast cancer surgery in First Medical Center,Chinese PLA General Hospital were enrolled.Patients were randomly divided into control group,Chinese medicine group and acupuncture+medicine group,with 64 cases in each group.Control group was given granisetron+dexamethasone intravenous drip,Chinese medicine group was given Xiaobanxia decoction orally based on control group,and acupuncture+medicine group was given acupuncture based on Chinese medicine group.Degrees of nausea and vomiting,complete control rate of vomiting and the incidence of adverse response in acute phase(day 1),delayed phase(days 2-5)and whole course(days 1-5)were compared among the three groups.Results In acute phase,delayed phase and whole course,degrees of nausea and vomiting in acupuncture+medicine group and Chinese medicine group were significantly better than those in control group,and those in acupuncture+medicine group were better than those in Chinese medicine group(all P<0.05).The complete control rate of nausea and vomiting in acupuncture+medicine group,Chinese medicine group and control group were 41.3%(26/63),17.2%(11/64)and 0 in acute phase,were 44.4%(28/63),34.4%(22/64)and 10.9%(7/64)in delayed phase and were 31.7%(20/63),15.6%(10/64)and 7.8%(5/64)in whole course,respectively,and the differences were statistically significant(all P<0.05).The incidence rate of adverse response in acupuncture+medicine group was significantly lower than that in Chinese medicine group and control group(χ^(2)=8.203,P=0.017).Conclusions Standardizing the full course of management before,during and after chemotherapy in patients with breast cancer after surgery can effectively reduce the occurrence of CINV.Traditional Chinese medicine treatment is used as a complementary treatment to standard treatment regimens for CINV,increasing efficacy while reducing the incidence of adverse response.