止吐用低频电刺激仪防治非小细胞肺癌患者化疗导致恶心呕吐的回顾性研究

A study on prevention and treatment of chemotherapy induced nausea and vomiting in non-small cell lung cancer patients with low-frequency electrical stimulator for antiemesis

背景与目的:晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受高致吐风险的含铂双药化疗,即使采用三联或四联止吐方案,仍有相当一部分患者会出现化疗后恶心呕吐。止吐用低频电刺激仪是一种穿戴式电子止吐仪,可有效地降低各种原因引起的恶心呕吐反应,然而,在三联止吐药物的基础上联合止吐用低频电刺激仪是否可进一步提高化疗导致的恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)的控制率,目前未见报道。本研究旨在评估止吐用低频电刺激仪辅助标准止吐药在应用高致吐化疗方案的NSCLC患者中的疗效和耐受性。方法:回顾性收集北京大学国际医院2019年12月1日—2022年12月30日接受一线高致吐化疗方案的晚期NSCLC患者,正确佩戴止吐用低频电刺激仪的患者作为观察组,未佩戴低频电刺激仪的化疗患者作为对照组。收集患者的临床特征、化疗后恶心呕吐发生情况,并进行患者化疗后的功能性生活指数-呕吐(functional living index-emesis,FLIE)问卷调查。采用SPSS 20.0进行统计学分析,比较两组间呕吐完全缓解率、恶心发生率和FLIE评分。结果:和对照组相比,试验组的全程无恶心率(66.3%vs 51.1%,P=0.036)和呕吐完全缓解率(83.7%vs 66.3%,P=0.006)显著提高;化疗后24~120 h的延迟期呕吐完全缓解率试验组显著提高(88.0%vs 69.6%,P=0.002),无恶心率显著提高(73.9%vs 57.6%,P=0.020)。试验组患者报告的FLIE总分和对照组患者相比差异有统计学意义(106.05±15.35 vs 95.04±20.02,P=0.020)。结论:本研究结果提示,在三联止吐方案的基础上,佩戴止吐用低频电刺激仪可改善NSCLC患者CINV的控制水平并提高患者生活质量,可作为三联止吐方案的有效补充。

Background and purpose:In patients with advanced non-small cell lung cancer(NSCLC)who receive platinumcontaining dual-drug chemotherapy with high emetic risk,a significant number of patients experience nausea and vomiting after chemotherapy,even if they are treated with a triple or quadruple antiemetic regimen.The low-frequency electrical stimulator for antiemesis is a wearable electronic antiemesis device,which can effectively reduce nausea and vomiting caused by various reasons.However,no studies have investigated whether the combination of three antiemetic drugs with low-frequency electrical stimulator can further improve the control rate of chemotherapy-induced nausea and vomiting(CINV).Therefore,the aim of this study was to assess the efficacy and tolerability of low-frequency electrical stimulator for antiemesis plus standard antiemetics following highly emetogenic chemotherapy in patients with NSCLC.Methods:Data of patients with advanced NSCLC who received firstline hyperemetic chemotherapy at Peking University International Hospital from December 1,2019 to December 30,2022 were retrospectively collected.Patients who correctly wore low-frequency electrical stimulator for antiemesis were selected as the observation group,and chemotherapy patients who did not wear low-frequency electrical stimulator were selected as the control group.Clinical characteristics,occurrence of nausea and vomiting after chemotherapy and functional living index-emesis(FLIE)questionnaire were collected.SPSS 20.0 was used for statistical analysis to compare the vomiting complete response rate,nausea incidence and FLIE score between the two groups.Results:Compared with the control group,the no nausea rate(66.3%vs 51.1%,P=0.036)and the complete response rate of vomiting(83.7%vs 66.3%,P=0.006)in experimental group were significantly increased.At 24-120 h after chemotherapy,the complete response rate of vomiting at the delayed stage increased conspicuously in the observation group(88.0%vs 69.6%,P=0.002).At this stage,the proportion of patients without nausea in the observation group was also significantly higher(73.9%vs 57.6%,P=0.020).The total FLIE scores were conspicuously higher in the observation group than in the control group(106.05±15.35 vs 95.04±20.02,P=0.020).Conclusion:The results suggest that,on the basis of the triple antiemesis regimen,wearing the low-frequency electrical stimulator can significantly improve the control level of CINV and the quality of life of NSCLC patients,which can be an effective supplement to the triple antiemesis regimen.