Clinical Efficacy of Ultrasonic Medicinal Penetration in the Removal of Blood Stasis and Alleviation of Zhuyu Juanbi Formula in the Treatment of Peripheral Neuropathy Induced by Paclitaxel

Objective: To observe the clinical efficacy and differences of the Zhuyu Juanbi formula delivered through ultrasound at Zusanli on patients with chemotherapy-induced peripheral neuropathy (CIPN) due to paclitaxel injection. Methods: A total of 72 breast cancer patients with CIPN were randomly divided into two groups. The treatment group (36 cases) was treated with oral methylcobalamin plus ultrasonic medicine permeating Zhuyu Juanbi formulae, while the control group (36 cases) was treated with oral methylcobalamin alone. Following two 2 cycles of continuous treatment, the efficacy of peripheral neurotoxicity, TCM syndrome score, FACT/GOG-Ntx score, total neuropathy score, and safety indicators of gynecological cancer patients were observed in the two groups. Result: In the treatment of CIPN, the addition of ultrasonic medicine permeating Zhuyu Juanbi formulae was more effective than oral methylcobalamin alone in reducing peripheral neurotoxicity and improving the quality of life of patients. The difference between the two groups was statistically significant (P < 0.05), and ultrasound drug penetration Zhuyu Juanbi formulae significantly reduced the FACT/ GOG-Ntx score and TNS score in the treatment group. In terms of drug safety, it rarely caused adverse reactions such as grade 3 and 4 leukopenia, and the safety profile was therefore good. Conclusion: The combination of ultrasonic medicine permeating Zhuyu Juanbi formulae and methylcobalamin has been demonstrated to be an effective treatment for peripheral neurotoxicity in patients with PIPN. It has been shown to significantly improve the clinical symptoms of PIPN patients, improve the quality of life of patients, and have a good safety profile.

Sigma-1 receptor: a new player in neuroprotection against chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy is a very frequent neurological complication in cancer. Oxaliplatin（OXA） is a platinum analogue used as a first-line agent in the treatment of colorectal cancer. OXA induced peripheral neuropathy（OIN） is the main toxicity both during and after the completion of chemotherapy that presents as two distinct syndromes： acute and chronic neuropathy. None of the neuroprotective agents previously tested had prevented or limited the acute and/or chronic OIN. MR309（previously developed as E-52862） is a novel selective sigma-1 receptor（S1R） antagonist with preclinical analgesic activity in OXA-induced neuropathic pain in animal models. This review analyzes the results of the recently published phase Ⅱ, randomized, double-blind, placebo-controlled clinical trial including 124 patients with colorectal cancer（CRC） treated with MR309. This study shows encouraging findings in the setting of neuroprotection against OIN with an acceptable safety profile. The study demonstrated MR309 usefulness in decreasing acute OIN, by reducing cold hypersensitivity experienced by patients, and pointed to the amelioration of chronic OIN by lowering the proportion of patients who developed severe chronic OIN. In addition, we provide a summary and discussion on the pathways that can be modulated by the S1R to explain the observed clinical benefits in the OIN.

Psychosocial adaptation and influencing factors among patients with chemotherapy-induced peripheral neuropathy

BACKGROUND Chemotherapy-induced peripheral neuropathy(CIPN)is a severe and longlasting side effect caused by various anticancer agents that damage sensory,motor and autonomic nerves.It can cause maladaptive behaviors,including disease severity,anxiety,depression,sleep disorders,falls,and social impairment.These disorders have physical,psychological and social effects on patients and can seriously influence their quality of life.AIM To investigate the current situation of psychosocial adaptation to the disease and its influencing factor in patients with CIPN.METHODS A convenience sampling method was used to select 233 patients with CIPN in our hospital from February to August 2021.In addition,a cross-sectional survey was conducted using a sociodemographic questionnaire,the Self-Report Psychosocial Adjustment to Illness Scale,and the European Organisation for the Research and Treatment of Cancer Quality of Life CIPN20(QLQ-CIPN20).Factors influencing psychosocial adaptation in patients with CIPN were analyzed by t-test or one-way analysis of variance,correlation analysis,multiple stepwise regression analysis,and structural equation models.RESULTS The psychosocial adaptation score of patients with CIPN was 52.51±13.18.Multivariate analysis showed that autonomic nerves,tumor stage,motor nerves,education level,availability of caregivers,semi-retirement status,CIPN grade were independent risk factors for patients with CIPN(P<0.05).Structural equation models showed that QLQ-CIPN20 mediated the relationship between CIPN grade,tumor stage,and psychosocial adaptation.CONCLUSION Patients with CIPN have poor psychosocial adaptation and are affected by a variety of physiological,psychological,and social factors.Patients’adaptive responses should be assessed,and targeted interventions implemented.

Insights into platinum-induced peripheral neuropathy–current perspective

Cancer is a global health problem that is often successfully addressed by therapy, with cancer survivors increasing in numbers and living longer world around. Although new cancer treatment options are continuously explored, platinum based chemotherapy agents remain in use due to their efficiency and availability. Unfortunately, all cancer therapies affect normal tissues as well as cancer, and more than 40 specific side effects of platinum based drugs documented so far decrease the quality of life of cancer survivors. Chemotherapy-induced peripheral neuropathy is a frequent side effects of platinum-based chemotherapy agents. This cluster of complications is often so debilitating that patients occasionally have to discontinue the therapy. Sensory neurons of dorsal root ganglia are at the core of chemotherapy-induced peripheral neuropathy symptoms. In these postmitotic cells, DNA damage caused by platinum chemotherapy interferes with normal functioning. Accumulation of DNA-platinum adducts correlates with neurotoxic severity and development of sensation of pain. While biochemistry of DNA-platinum adducts is the same in all cell types, molecular mechanisms affected by DNA-platinum adducts are different in cancer cells and non-dividing cells. This review aims to raise awareness about platinum associated chemotherapy-induced peripheral neuropathy as a medical problem that has remained unexplained for decades. We emphasize the complexity of this condition both from clinical and mechanistical point of view and focus on recent findings about chemotherapy-induced peripheral neuropathy in in vitro and in vivo model systems. Finally, we summarize current perspectives about clinical approaches for chemotherapy-induced peripheral neuropathy treatment.

Treatment of Chronic Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review

Introduction: Oxaliplatin is a platinum-derivative chemotherapeutic agent used in digestive tumours, in the adjuvant and metastatic setting. Oxaliplatin can cause a chronic peripheral sensory neuropathy which impacts the quality of life and is dose limiting. To date, no therapeutic strategies have proved effective in the treatment of oxaliplatin-induced peripheral neuropathy (OIPN). Methods: A computerized search of the literature on PubMed database was performed. Publisher original articles were included if they focused on treatment of peripheral neuropathy among patients submitted to oxaliplatin. Eleven out of 242 reviewed papers met our inclusion criteria and were subjected to a 19-item quality checklist. Results: The included studies differed with respect to study design, patient population and sample size, neuropathic symptoms assessment and efficacy measure. Most studies had an adequate quality. Ten trials tested one drug, and one pilot study tested a non-pharmacological treatment—the neurofeedback. Of these, 3 trials included only patients submitted to oxaliplatin-based chemotherapy. Duloxetine showed moderate efficacy in 3 trials. Topical treatment with capsaicin or 10% amitriptyline was promisors in 2 single-arm trials with a few samples. Conclusion: In the last decade, there wasn’t an improvement in the treatment of chronic OIPN. The duloxetine is the unique drug with moderate efficacy on the treatment of OIPN. There is insufficient evidence to support a recommendation for any other treatment.

Analgesic efficacy of median nerve stimulation in mice with chemotherapy-induced peripheral neuropathy via modulation of brain-derived neurotrophic factor expression

OBJECTIVE:Chemotherapeutic agents such as docetaxel(DTX)can trigger chemotherapy-induced peripheral neuropathy(CIPN),which is characterized by unbearable pain.This study was designed to investigate the analgesic effect and related neuronal mechanism of low-frequency median nerve stimulation(LFMNS)on DTX-induced tactile hypersensitivity in mice.METHODS:To produce CIPN,DTX was administered intraperitoneally 4 times,once every 2 d,to male ICR mice.LFMNS was performed on the wrist area,and the pain response was measured using von Frey filaments on both hind paws.Western blot and immunofluorescence staining were performed using dorsal root ganglion and spinal cord samples to measure the expression of brainderived neurotrophic factor(BDNF).RESULTS:Repeated LFMNS significantly attenuated the DTX-induced abnormal sensory response and suppressed the enhanced expression of BDNF in the DRG neurons and spinal dorsal area.CONCLUSIONS:LFMNS might be an effective nonpharmaceutical option for treating patients suffering from CIPN via regulating the expression of peripheral and central BDNF.

Chemotherapy-induced neurotoxicity in the treatment of gynecological cancers:State of art and an innovative approach for prevention

Chemotherapy-induced peripheral neuropathy(CIPN)is a common side effect that occurs in 20%of ovarian cancer patients treated with the combination of carboplatin/paclitaxel(CP).This toxicity is directly correlated with the dose of paclitaxel administered.Several studies have investigated whether different formulations of taxane can induce this side effect at a lower rate,but,unfortunately,no significant improvement was obtained.CIPN can be disabling in the daily lives of patients and can cause dose reduction or early termination of the treatment.Neuropathy can last for months and even years after its onset.Moreover,patients responsive to CP treatment are candidates for a reintroduction of the same drugs when disease relapse occurs,and residual neuropathy can affect the continuation of treatment.There are no approved drugs that mitigate or prevent the onset of CIPN.In this review,we summarize the evidence regarding the incidence of CIPN with different taxane formulations,regimen schedules and prevention systems.In particular,the Hilotherm®Chemo care device is a regional cooling system that lowers the temperature of the hands and feet to reduce the flow of chemotherapy into the capillaries.We used hilotherapy during chemotherapy infusion to prevent the onset of CIPN.Updated data from 44 ovarian cancer patients treated with 6 cycle of CP show that hilotherapy was well tolerated;only two patients(4.5%)stopped hilotherapy because of cold intolerance,and only one patient(2.2%)experienced grade≥2 CIPN.

Clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy of patients with breast cancer

Objective To observe the clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy （ClPN）. Methods Ninety ClPN patients with breast cancer conforming to inclusive criteria were randomly divided into an acupuncture group （group A）, a mecobalamin group （group B） and an acupoint injection group （group C） according to random number table, with 30 cases in each group. In group A, acupuncture was conducted at bilateral Q0chi （I~ LI 11）, H6g6 （~ LI 4）, Z0s^nlT （~__~ ST 36）, S^nyinji^o （^-- ~ SP 6） and Xu^h~i （J~ SP 10）; in group B, intramuscular injection with I mL of mecobalamin injection was conducted; and in group C, acupoint selection was the same as group A, and 0.1 mL of mecobalamin injection was injected into each acupoint, respectively. The treatment was conducted once every three days in each group, and the changes of clinical efficacy, nerve electrophysiology and hemorrheology indicators after treatment for 10 times were observed. Result The total effective rate of group C was 93.1% （27/29）, which was higher than 78.6% （22/28） in group A and 83.3% （25/30） in group B, and the differences among three groups were statistically significant （all P〈0.01）; conduction velocity of lesion nerves was improved in group B and group C, the improvement in group C was obviously superior to the other two groups （all P〈0.01）, hemorrheology indicator was improved in group A and group C （both P〈0.05）. Conclusion The efficacy of acupoint injection with mecobalamin for breast cancer CIPN was significant, which can not only improve the nerve conduction velocity, but also improve the hemorrheology indicator.

Sodium Aescinate Alleviates Neuropathic Pain in Rats by Suppressing the TLR4/NF KB Pathway Activation after Paclitaxel Chemotherapy

Background: Emerging evidence suggests that chemotherapy-induced peripheral neuropathy (CIPN) is a significant side effect of chemotherapeutic drugs. Many experiments have proved that sodium aescinate (SA) has definite pharmacological effects such as anti-infection, anti-exudation, anti-edema, anti-tumor as well as neuroprotection, and the drug side effects are mild. However, no study has explored whether SA is involved in the analgesic effect of paclitaxel (PAC) induced neuropathic pain in rats. Methods: Rats were given an intraperitoneal injection of PAC (2.5 mg/Kg intraperitoneally on days 1, 3, 5, and 7), while SA 25 mg/kg intraperitoneally was administered daily for 14 consecutive days. The mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of rats were examined on experimental days 3, 5, 7, 11, 14. All rats were sacrificed on day 15 of the experiment, and L4-6 spinal cords were removed. Subsequently, immunohistochemistry, HE staining, ELISA, RT-qPCR, Western blotting were applied to evaluate cytoskeletal protein expression (NF-L and NF-M), spinal nerve structural integrity, proinflammatory factor contents (TNF-α, IL-1β, and IL-6), and protein content of the TLR4/NF-κB pathway, respectively. Results: After the rats developed PAC induced pain behaviors, multiple injections of SA rendered the rats with elevated MWT and TWL values, decreased expression of NF-L and NF-M in the spinal cord, materially downregulated content of proinflammatory factors, and reduced amounts of TLR4 and p-NF-κB protein levels. Conclusions: The results of the present study preliminarily indicate that SA has an analgesic effect on rats with CIPN induced by PAC injection, and the mechanism may be related to blocking the TLR4/NF-κB signaling pathway, inhibiting the expression of proinflammatory factors, and alleviating cytoskeletal disorders.

Effect of electroacupuncture on chemotherapy-induced peripheral neuropathy in patients with malignant tumor：a single-blinded,randomized controlled trial

OBJECTIVE:To evaluate the effect of electroacupuncture on chemotherapy-induced peripheral neuropathy(CIPN), quality of life and immune status of patients with malignant tumors.METHODS:From Jan, 2013 to May, 2014, 37 patients with malignant tumors were included in this prospective single-blinded study, and randomized to receive either electroacupuncture or acupuncture treatment on basis of chemotherapy.The chemotherapy was continued for 2 courses as previous before the treatments, with 21 days as a course of treatment.Patients received acupuncture and electroacupuncture once per day starting at the day before chemotherapy for consecutive 7 days followed by 14 days off, with 21 days as a course of treatment, and continued for two courses of treatment.Then CIPN, traditional Chinese clinical symptoms,quality of life and immune status were all evaluated for each patient prior treatment and after two courses of treatment.RESULTS:The gender, age, cancer species as well as incidence(83.3% vs 84.2%) and grades of CIPN before treatments were all similar in patients receiving acupuncture or electroacupuncture(all P >0.05).After treatments, most patients with peripheral neuropathy were cured by two courses of electroacupuncture(84.2% vs 21.1%), whereas the other group of patients had similar incidences of peripheral neuropathy compared with prior-acupuncture(83.3% vs 72.2%).Besides, patients receiving electroacupuncture had lower incidence of peripheral neuropathy than those receiving acupuncture treatment(χ~2= 9.745, P = 0.002).The grades of peripheral neuropathy were significantly different in the two groups post-treatment(χ~2= 13.983, P =0.007).The total effective rates for traditional Chinese clinical symptoms were 16.7% and 84.2% in acupuncture and electroacupuncture groups, respectively(Z =-4.239, P < 0.001).The electroacupuncture treatment provided a more satisfactory life for patients compared with acupuncture(Z =-4.76, P < 0.001).Both electroacupuncture and acupuncture had no effects on immune function.CONCLUSION:Electroacupuncture could alleviate CIPN, and improve traditional Chinese clinical symptoms and quality of life, but did not affect immune function.

儿童急性B淋巴细胞白血病合并化疗诱导周围神经病变的临床特点及预后分析

目的总结急性B淋巴细胞白血病(B-ALL)患儿发生化疗诱导的周围神经病变(CIPN)特征,探讨CIPN发生及预后的危险因素。方法回顾性分析2020年6月至2023年12月苏州大学附属儿童医院血液肿瘤科29病区收治的接受化疗并已结束化疗6个月的60例B-ALL患儿的临床资料。结果B-ALL合并CIPN共37例,CIPN发生率为61.7%;发病年龄增加是儿童发生CIPN的危险因素[OR=1.209,95%CI(1.023~1.428),P=0.026];感觉神经功能障碍发生率(78.4%)最高;肌电图检查提示B-ALL合并CIPN为具有一定可逆性的多发性周围神经源性损害;化疗各阶段中在诱导期出现CIPN的有13例(35.1%),占比最高;结束化疗后6个月CIPN好转率67.6%,发病年龄[OR=2.418,95%CI(0.212~2.106),P=0.018]及CIPN严重程度[OR=203.394,95%CI(2.29~18065.04),P=0.02]为CIPN患儿预后的危险因素,发病年龄越大、CIPN严重程度越高,预后较差。结论B-ALL患儿合并CIPN为可逆性多发性周围神经损害,CIPN的发生及转归可能与患儿的个体差异有关。

不同温度的间断性手足低温疗法对乳腺癌化疗致外周神经毒性的干预效果

目的:探讨不同温度的间断性手足低温疗法对乳腺癌病人紫杉类药物诱导的外周神经毒性(CIPN)、手足综合征(HFS)和生活质量的干预效果。方法:选取2022年8月—2023年5月在唐山市某三级甲等医院收治的72例乳腺癌病人作为研究对象,随机分为试验1组和试验2组,每组36例。两组化疗期间均给予间断性手足低温疗法,每次输注紫杉类药物前后15 min,试验1组与试验2组分别佩戴-10~0℃与-30~-20℃冷冻手套和脚套,于干预前、干预2、4、6个周期后测评CIPN、HFS和生活质量的差异性及低温疗法的耐受性和安全性。结果:试验2组在干预4、6个周期后CIPN和HFS发生率及严重程度均低于试验1组,躯体功能、情绪功能、社交功能、总体健康状况、疲劳、失眠评分差值均低于试验1组,差异均有统计学意义(均P<0.05)。两组病人均无因不能耐受而退出试验者。结论:温度较低的间断性手足低温疗法更能有效预防CIPN和HFS发生及严重程度,提高病人生活质量。

Mechanism of electroacupuncture on “Zusanli( ST 36) ”for chemotherapy-induced peripheral neuropathy

Objective To observe the effects and duration of electroacupuncture on the mechanical pain threshold induced by paclitaxel and explore its analgesic mechanism.Methods Sixty-four C57BL/6J male mice were randomly divided into 4 groups,a normal+sham EA group,a normal+EA group,a medicine+sham EA(Med+sham EA)group,a medicine+EA(Med+EA)group。

SUDOSCAN 检测快速有效评估硼替佐米致周围神经病变

目的:本研究旨在探索SUDOSCAN检测(一种外周自主神经功能检测工具)对硼替佐米致周围神经病变(bortezomib-induced peripheral neuropathy,BIPN)的评估效果。方法:以2021年7月至2022年10月首都医科大学附属北京朝阳医院血液科确诊的86例多发性骨髓瘤(multiple myeloma,MM)患者作为研究对象,另外选取30例无肿瘤史及化疗药物接触史的患者作对照,所有患者均接受了SUDOSCAN皮肤电导率(ESC值)检测,同时与总神经病变评分临床版(TNSc)、美国国立癌症研究所常见毒性分级标准(NCI-CTC)分级评分对比,并对试验组患者进行了评估所需时间比较。结果:试验组患者手部、足部ESC值比对照组明显降低(手部:56.4μs vs.76.5μs,P<0.001;足部:47.5μs vs.78.0μs,P<0.001);SODUSCAN评估患者足部ESC值与TNSc评分呈显著负相关(r=−0.403,P<0.001)、与NCI-CTC等级无明显相关性(r=−0.227,P=0.051);NCI-CTC等级与TNSc评分呈显著正相关(r=0.591,P<0.001)。SUDOSCAN检测所需中位评估时间与NCI-CTC等级相近(均为2.4 min),TNSc评分所需中位评估时间最长(13.4 min)。结论:目前,BIPN缺乏准确、高效评估方式,SUDOSCAN检测简单易行,与TNSc评分呈显著负相关,且比TNSc评分用时更短,能够快速有效评估BIPN。

159例多发性骨髓瘤化疗相关周围神经病变中医证型研究

【目的】基于聚类分析探索多发性骨髓瘤化疗相关周围神经病变(MM-CIPN)的中医证型分布规律。【方法】纳入159例MM-CIPN患者的中医四诊信息,运用系统聚类分析和K-均值聚类分析方法,归纳总结该病的高频证候及其中医证型。【结果】(1)共筛选出27个高频证候,其中,频率超过50%的证候有5个,分别是肢体麻木151例(占95.0%)、肢体刺痛115例(占72.3%)、畏寒肢凉93例(占58.5%)、疲倦乏力89例(占56.0%)和屈伸不利82例(占51.6%)。(2)根据两种聚类分析方法,可将MM-CIPN的中医证型分为气虚血瘀证、痰瘀痹阻证、肾虚血瘀证、阴虚血瘀证4型,其中,以气虚血瘀证及肾虚血瘀证居多,阴虚血瘀证、痰瘀痹阻证次之。(3)中医证候分型与患者性别无显著相关性(P>0.05)。年龄方面,在34~40岁和41~50岁年龄段,均以痰瘀痹阻证所占比例最高,分别为75.0%(3/4)和44.5%(4/9);在51~60岁和61~70岁年龄段,均以气虚血瘀证所占比例最高,分别为56.9%(29/51)和43.6%(30/69);在71~80岁年龄段,以肾虚血瘀证所占比例最高,为46.2%(12/26),其次为阴虚血瘀证,占26.9%(7/26)。【结论】肢体麻木、肢体刺痛为MM-CIPN的主要证候;MMCIPN的中医证型以气虚血瘀证及肾虚血瘀证居多,阴虚血瘀证、痰瘀痹阻证次之;不同年龄段患者的中医证型有所差异,中年患者以痰瘀痹阻证居多,中老年患者以气虚血瘀证多见,老年患者以肾虚血瘀证及阴虚血瘀证所占比例较高。

中医外治法治疗紫杉类药物所致周围神经毒性研究进展

紫杉类化疗药是临床常用的抗肿瘤药物,其所致的周围神经毒性(chemotherapy-induced peripheral neuropathy, CIPN)是最常见的毒副反应之一,现代医学治疗主要包括抗氧化剂、神经营养及抗抑郁药物等。中医药治疗CIPN取得一定成效,尤其是中医外治法(中药熏洗、针刺治疗、中药塌渍及按摩等)不仅可以弥补口服汤剂加重胃肠道反应的不足,且具有安全廉验的优势。目前研究存在的问题是,紫杉烷的神经毒性临床常见,而研究多围绕奥沙利铂引起的周围神经毒性进行,紫杉类药物仍缺乏基础研究和临床试验。无论是中药熏洗还是针灸治疗,都缺乏大资料研究作为支撑点,且中药作用于周围神经毒性的具体机理和靶点仍需深入探索。今后,应开展大样本的随机、对照、双盲实验,为紫杉类药物神经毒性的防治提供切实可行的方案,发挥中医外治法的传统特色。

针灸干预肿瘤化疗、手术后不良反应的临床研究

恶性肿瘤严重威胁人类的生命和健康,已成为人类死亡的主要病因之一,放化疗和手术为主要治疗手段,然而其引起的一系列不良反应严重影响肿瘤患者的生命质量。本文以天津中医药大学针灸临床评价与转化中心近6年来开展的针灸治疗肿瘤放化疗后的恶心呕吐(CINV)、乳腺癌术后上肢淋巴水肿(BCRL)和化疗所致周围神经病变(CIPN)的研究结果,结合美国国家癌症研究所(NCI)发布的针灸在肿瘤研究方面的共识及最新临床证据摘要(PDQ?),对针灸在干预肿瘤化疗、手术后不良反应中的临床研究进行总结评述,以挖掘和探索针灸在肿瘤治疗中的应用价值,为以上病症的治疗提供有效的方法。

硫辛酸联合葡萄糖酸钙及硫酸镁对恶性肿瘤化疗所致的周围神经病变的疗效观察

目的探讨硫辛酸联合葡萄糖酸钙/硫酸镁对恶性肿瘤化疗药物所致周围神经病变(CIPN)的治疗效果。方法将179例接受化疗并明确诊断为CIPN的恶性肿瘤患者随机分为对照组(90例)和研究组(89例),对照组患者给予葡萄糖酸钙10 ml和25%硫酸镁10 ml注入5%葡萄糖溶液静脉滴注;研究组患者在对照组治疗的基础上加用α-硫辛酸注射液600 mg入0.9%氯化钠注射液静脉滴注。2组均治疗24天,观察2组患者治疗前后正中神经和腓总神经的传导速度,采用视觉模拟评分(VAS)评价治疗前后疼痛情况,并评估治疗效果和不良反应。结果研究组和对照组治疗后正中神经和腓总神经的传导速度均较治疗前有不同程度的提高(P<0.05、P<0.01),但研究组较对照组神经传导速度提高更显著(P<0.05)。研究组治疗后VAS评分较治疗前显著下降(P<0.05),而对照组治疗前后VAS评分无显著差异(P>0.05)。治疗24天后,研究组治疗总有效率为95.51%(85/89),显著高于对照组的83.33%(75/90)(P<0.05)。2组不良反应发生率无显著差异(12.36%vs 8.89%,P>0.05),均无严重不良反应发生。结论硫辛酸联合葡萄糖酸钙及硫酸镁能够加快恶性肿瘤CIPN患者感觉及运动神经的传导速度,改善患者的临床症状和体征,具有协同作用,且用药安全,值得临床应用。

化疗所致周围神经毒性评估和管理的证据总结

目的评价和总结化疗所致周围神经病变评估和管理的最佳证据。方法计算机检索中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Up To Date、BMJ best practice、Web of Science、Cochrane Library、JBI OVID、PubMed、国际指南协作网(GIN)、英国国家卫生与临床优化研究所指南网(NICE)、安大略注册护士协会(RNAO)、美国国家综合癌症网(NCCN)、苏格兰院际指南网(SIGN)等国内外数据库,检索数据库中建库至2020年7月29日该研究领域的所有化疗所致周围神经病变(chemotherapy-induced peripheral neuropathy,CIPN)相关文献,汇总有关CIPN评估和管理的证据。结果共纳入9篇文献,其中指南1篇,证据总结1篇,系统评价4篇,临床决策1篇,实践推荐1篇、专家共识1篇。共汇总24条最佳证据,包括评估与计划、多学科合作、健康教育、非药物管理、药物管理5个维。结论护理人员应从循证的角度对化疗所致周围神经毒性进行评估和管理,根据证据的不断更新,汇总最佳证据,提升护理质量。

不同频率电针治疗紫杉类化疗药物所致周围神经病变:随机对照试验

目的:观察2 Hz、100 Hz、2 Hz/100 Hz不同频率电针治疗紫杉类化疗药物所致周围神经病变(CIPN的临床疗效。方法:将160例女性乳腺癌采用紫杉类化疗药物所致CIPN患者随机分为2 Hz电针组(40例,脱落1例)、100 Hz电针组(40例,脱落2例)、2 Hz/100 Hz电针组(40例,脱落3例)及西药组(40例,脱落2例)。3个电针组均于双侧曲池、外关、合谷、足三里、阳陵泉等穴进行针刺,同侧合谷与外关、足三里与三阴交分别连接HANS-200E型韩氏穴位神经刺激仪电极,分别予频率2 Hz、100 Hz及2 Hz/100 Hz电针刺激,每次30 min,隔日1次,每周治疗3次。西药组予口服甲钴胺片治疗,每次0.5 mg,每天3次。各组均连续治疗4周。于治疗前、治疗后及全部治疗结束后4周随访,观察各组肿瘤患者神经毒性评估量表(FACT/GOG-Ntx)评分、美国国立癌症研究所评定标准(NCI CTCAE V 5.0)的周围神经毒性分级、周围神经痛视觉模拟量表(VAS)评分,并于治疗后评定临床疗效。结果:治疗后及随访时,各组患者FACT/GOG-Ntx评分较治疗前降低(P<0.01);治疗后,3个电针组FACT/GOG-Ntx评分降低幅度大于西药组(P<0.01,P<0.05),2 Hz电针组与2 Hz/100 Hz电针组降低幅度大于100 Hz电针组(P<0.05);随访时,2 Hz电针组、2 Hz/100 Hz电针组FACT/GOG-Ntx评分降低幅度大于西药组(P<0.01)。治疗后,3个电针组周围神经毒性分级较治疗前改善(P<0.01);随访时,2 Hz电针组与2 Hz/100 Hz电针组周围神经毒性分级较治疗前改善(P<0.01)。治疗后,3个电针组周围神经痛VAS评分较治疗前降低(P<0.01,P<0.05);随访时,2Hz电针组、2Hz/100Hz电针组和西药组周围神经痛VAS评分较治疗前降低(P<0.01,P<0.05);治疗后及随访时,2 Hz/100 Hz电针组VAS评分降低幅度大于西药组(P<0.01,P<0.05)。治疗后,2 Hz电针组、100 Hz电针组、2 Hz/100 Hz电针组、西药组总有效率分别为79.5%(31/39)、68.4%(26/38)、81.1%(30/37)、47.4%(18/38),2 Hz电针组与2 Hz/100 Hz电针组总有效率高于西药组(P<0.05)。结论:电针能有效治疗紫杉类化疗药物所致CIPN,但不同频率电针的疗效总体没有差异,2Hz电针与2 Hz/100 Hz电针的疗效具有潜在优势;对于合并周围神经痛患者,更推荐采用2 Hz/100 Hz电针治疗。