姜橘暖胃膏穴位贴敷联合托烷司琼和地塞米松预防化疗所致恶心呕吐的临床疗效研究

doi:10.12114/j.issn.1007-9572.2020.00.177

摘要/Abstract

摘要： 背景　化疗所致恶心呕吐（CINV）是肿瘤治疗过程中常见的不良反应之一。中药穴位贴敷作为中医特色疗法，在防治CINV方面可发挥一定疗效，研究穴位贴敷预防CINV，对于提高肿瘤患者化疗期间的生活质量具有重要意义。目的　了解姜橘暖胃膏穴位贴敷联合托烷司琼和地塞米松预防CINV的疗效。方法　纳入2018年5—12月在广州中医药大学第一附属医院、原广州军区总医院肿瘤科住院的胃肠道肿瘤化疗患者共140例为研究对象，采用随机数字表法分为姜橘暖胃膏组75例，对照组65例（剔除首次化疗前确认不能继续参与研究者）。后续过程中姜橘暖胃膏组脱落10例，对照组脱落4例。对照组在化疗时接受常规预防CINV方案（托烷司琼和地塞米松静脉推注），姜橘暖胃膏组在常规预防方案的基础上加予姜橘暖胃膏穴位贴敷。化疗第1~5天每日记录患者恶心呕吐情况及相关不良反应，于化疗第5天采用生活质量核心量表（QLQ-C30）评价生活质量。结果　姜橘暖胃膏组急性期CINV的有效控制率（ORR）与对照组比较（98.5%比91.2%），差异无统计学意义（P=0.10）；姜橘暖胃膏组延迟期CINV的ORR高于对照组（100.0%比81.3%），差异有统计学意义（P=0.02）。姜橘暖胃膏组第2~4天的呕吐发生率低于对照组，差异有统计学意义（P<0.05）。姜橘暖胃膏组患者第1~5天恶心发生率低于对照组，差异有统计学意义（P<0.05）。姜橘暖胃膏组患者总体生活质量较对照组改善（P<0.05），主要体现在疲乏和恶心呕吐、食欲丧失、腹泻、便秘等胃肠道症状方面（P<0.05）。两组解救治疗使用率比较，差异无统计学意义（P>0.05）。结论　姜橘暖胃膏穴位贴敷联合托烷司琼和地塞米松对延迟性CINV有效，并能缓解疲乏及胃肠道症状，提高患者总体的生活质量，可进一步研究推广。

关键词: 胃肠肿瘤, 姜橘暖胃膏, 穴位贴敷法, 恶心, 呕吐, 治疗结果, 生活质量

Abstract: Background　Chemotherapy-induced nausea and vomiting（CINV） is one of the common adverse reactions in the treatment of tumors.Acupoint application，as a characteristic therapy of traditional Chinese medicine，can play a certain role in the prevention and treatment of CINV.The study on acupoint application in preventing CINV is of great significance for improving the quality of life of cancer patients during chemotherapy.Objective　To explore the clinical efficacy of acupoint application of ginger and citri reticulatae stomach-warming ointment combined with Tropisetron and Dexamethasone in preventing CINV.Methods　A total of 140 patients with chemotherapy of gastrointestinal tumors who were hospitalized in the Department of Oncology in the First Affiliated Hospital of Guangzhou University of Chinese Medicine and the General Hospital of Guangzhou Military Region were selected as the study objects from May to December in 2018.They were divided into the ginger and citri reticulatae stomach-warming ointment group（75 cases） and the control group（65 cases） using the random number table method（excluding those were unable to continue the study before the first chemotherapy）.In the follow-up process，10 cases in ginger and citri reticulatae stomach-warming ointment group and 4 cases in control group dropped out.The control group received the conventional CINV prevention plan（intravenous injection of tropisetron and dexamethasone） during chemotherapy，and the other group was added with acupoint application of ginger and citri reticulatae stomach-warming ointment on the basis of conventional prevention plan.Nausea and vomiting and related adverse reactions were recorded daily from the first day to the fifth day of chemotherapy.The EORTC core quality of life questionnaire（QLQ-C30） was used to evaluate the quality of life on the fifth day of chemotherapy.Results　There was no significant difference in the effective control rate （ORR） of CINV between ginger and citri reticulatae stomach-warming ointment group and control group（98.5% vs 91.2%，P=0.10）.The ORR of delayed CINV in the ginger and citri reticulatae stomach-warming ointment group was higher than that in the control group（100.0% vs 81.3%），and the difference was statistically significant（P=0.02）.The incidence of vomiting in ginger and citri reticulatae stomach-warming ointment group was lower than that in the control group with a statistically significant difference on the second，third and fourth days （P<0.05）.The incidence of nausea in ginger and citri reticulatae stomach-warming ointment group was lower than that in the control group from the first day to the fifth day（P<0.05）.The overall quality of life of the patients in ginger and citri reticulatae stomach-warming ointment group was significantly improved compared with the control group（P<0.05），which was mainly manifested in fatigue and gastrointestinal symptoms such as nausea and vomiting，loss of appetite，diarrhea，and constipation（P<0.05）.However，there was no significant difference in the utilization rate of salvage treatment between the two groups（P>0.05）.Conclusion　The acupoint application of ginger and citri reticulatae stomach-warming ointment combined with Tropisetron and Dexamethasone is effective for delayed CINV.It can relieve fatigue and gastrointestinal symptoms and improve the overall quality of life of patients，which can be further studied and promoted.

Key words: Gastrointestinal neoplasms, Ginger and citri reticulatae stomach-warming ointment, Acupoint sticking therapy, Nausea, Vomiting, Treatment outcome, Quality of life

蒋梅,周岱翰,郭然,等. 姜橘暖胃膏穴位贴敷联合托烷司琼和地塞米松预防化疗所致恶心呕吐的临床疗效研究[J]. 中国全科医学, 2020, 23(16): 2051-2056. DOI: 10.12114/j.issn.1007-9572.2020.00.177.
JIANG Mei,ZHOU Daihan,GUO Ran, et al. Clinical Effect of Ginger and Citri Reticulatae Stomach-warming Ointment Combined with Tropisetron and Dexamethasone in Preventing Chemotherapy-induced Nausea and Vomiting　[J]. Chinese General Practice, 2020, 23(16): 2051-2056. DOI: 10.12114/j.issn.1007-9572.2020.00.177.

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