掀针治疗肿瘤化疗所致恶心、呕吐的应用效果

目的 探讨掀针治疗肿瘤化疗所致恶心、呕吐(chemotherapy-induced nausea and vomiting,CINV)的临床效果.方法 2018年12月至2019年12月,采便利抽样法选取在广东省某三级甲等医院进行化疗的脾胃虚弱型肿瘤患者120例为研究对象,按随机数字表法将其分为观察组和对照组各60例,...     

肿瘤化疗所致恶心呕吐现状调查

目的调查化疗所致恶心呕吐（chemotherapy—inducednauseaandvomiting,CINV）的患者心理预期和发生情况,并评估CINV对患者生活质量的影响,为提高临床医生对CINV的认识和重视提供依据。方法采用问卷调查的方式,调查华中科技大学同济医学院附属同济医院使用中度致吐风险化疗（MEC）或高度致吐风险化疗（HEC）的患者,并对其进行连续两周期相同化疗方案的随访。患者分别于化疗开始前、化疗第2天和化疗第6天,记录化疗期间急性、延迟性恶心呕吐发生情况、自主止吐用药和CINV对生活功能的影响,调查结果采用描述性分析和多元线性回归分析。结果本研究共调查344例患者,最终303例患者完成问卷调查。结果显示：单日化疗MEC组急性、延迟性和总的完全缓解率分别为86．1％、76．6％和71．5％,HEC组为84．1％、71．0％和66．7％。多日化疗患者分别为93．8％、64．9％和64．9％;第2周期化疗前患者关于恶心呕吐预期值和焦虑值与患者前一周期化疗延迟性恶心发生的严重程度密切相关;约30％的患者因CINV对生活功能造成负面影响。结论在行中度和高度致吐风险化疗的患者中,CINV治疗现状仍存在较大问题,尤其是在延迟期反应和恶心症状的控制方面。在临床实践中需进一步加强对CINV的关注,并提供更加有效的治疗措施。     

基于循证的非药物干预方案在妇科肿瘤病人化疗所致恶心呕吐中的应用北大核心

目的:基于循证方法构建妇科肿瘤病人化疗所致恶心呕吐(CINV)的非药物干预方案,并探讨应用效果。方法:基于循证方法构建CINV非药物干预方案,选取青岛市某医院120例妇科肿瘤病人为研究对象,将2021年2月—2021年5月收治的60例病人作为对照组,将2021年6月—2021年9月收治的60例病人作为试验组,对照组进行常规护理,试验组在常规护理基础上实施CINV非药物干预方案。比较两组病人CINV发生情况、焦虑和抑郁情况及对护理工作的满意度。结果:试验组急性期恶心程度得分为(4.15±1.13)分,低于对照组[(5.08±1.27)分];试验组延迟性呕吐发生率为18.3%,恶心发生率为46.7%,恶心程度得分为(4.22±0.80)分,均低于对照组[呕吐发生率为36.7%,恶心发生率为65.0%,恶心程度得分为(4.72±1.06)分];试验组出院当天焦虑自评量表(SAS)得分为(50.10±4.98)分,抑郁自评量表(SDS)得分为(51.29±5.13)分,均低于对照组[SAS得分为(56.07±6.32)分,SDS得分为(56.51±5.22)分];试验组满意度为(28.22±5.33)分,高于对照组[(25.65±7.18)分],差异均有统计学意义(P<0.05)。结论:在妇科肿瘤病人中实施基于循证方法制定的CINV非药物干预方案,有利于缓解CINV,减轻病人负性情绪,提高病人满意度。     

多学科协作下全程管理在肿瘤患者化疗所致恶心呕吐中的应用研究

目的 探讨多学科协作下全程管理在肿瘤患者化疗所致恶心呕吐中的应用及实施效果。方法 选取2019年1月至11月在某肿瘤医院中西医结合科接受静脉化疗的肿瘤患者524例为研究对象,按照住院时间分为对照组258例和观察组266例;对照组实施常规护理,观察组在对照组基础上实施多学科协作下全程管理,比较两组患者化疗所致恶心呕吐发生情况及满意度。结果 干预后观察组患者化疗所致恶心呕吐发生率和发生等级均低于对照组（P<0.01或P<0.05）,患者满意度显著高于对照组（P<0.05）。结论 多学科协作下全程管理改善了肿瘤化疗患者恶心呕吐的症状,提高了患者满意度。     

肿瘤患者化疗所致恶心呕吐的护理干预

目的探讨护理干预对血液科肿瘤患者化疗所致恶心、呕吐(CINV)的影响。方法将107例接受化疗方案的血液科肿瘤患者随机分为干预组54例与对照组53例,2组均接受常规护理,干预组另加心理干预、行为干预、饮食干预。结果干预组患者的预期性、急性、延迟性CINV的发生率均较对照组明显降低,程度较对照组明显减轻(P<0.05)。结论护理干预在减少血液科肿瘤患者的CINV中起积极作用,通过心理干预、行为干预、饮食干预,可使患者恶心、呕吐的发生率明显降低,程度减轻。     

肿瘤化疗恶心、呕吐的护理体会

自2004年3月～2004年10月共收到肿瘤病人52例，对化疗恶心、呕吐的护理体会如下：     

心理护理对妇科恶性肿瘤化疗患者生活质量的影响分析

目的：了解妇科恶性肿瘤患者化疗前后生活质量变化,探讨心理干预对其生活质量的影响。方法：将86例妇科恶性肿瘤化疗患者随机分为观察组40例和对照组46例。观察组采用常规化疗和护理的同时给予心理护理,对照组仅采用常规化疗及护理。采用欧洲癌症研究与治疗组织研制的生活质量测定量表（EORTCQLQ-C30）,对妇科恶性肿瘤化疗患者进行生活质量测量和评价。结果：观察组患者治疗后生活质量优于对照组（P＆lt;0.01）,观察组治疗后恶心、呕吐、倦怠乏力等副反应的发生情况明显少于对照组（P＆lt;0.01）,腹泻症状两组无明显差异（P＆gt;0.05）。结论：妇科恶性肿瘤患者化疗前后存在不良心理状态,实施系统的心理护理能提高妇科恶性肿瘤术后患者的生存质量。     

妇科肿瘤化疗后呕吐防治的临床研究

化疗是妇科恶性肿瘤的主要治疗手段之一，化疗药物的消化道反应在临床很常见．它是限制化疗药物剂量及影响化疗顺利完成的重要因素，因此，有效地控制化疗的消化道反应，对化疗顺利实施及改善生存质量都十分重要。欧必亭是目前唯一与5-HT主环结构完全相同的5-HT3受体拮抗剂。作者对102例联合化疗的妇科恶性肿瘤患者，应用欧必亭与恩丹西酮进行对照观察，报告如下。     

综合护理干预对妇科肿瘤化疗患者心理状况和生活质量的影响

目的：探讨护理干预对妇科肿瘤化疗患者心理状况和生活质量的影响。方法选取72例妇科肿瘤化疗患者,随机分为试验组和对照组,对照组仅给予常规护理,治疗组采用综合护理干预,比较两组患者抑郁自评量表（SDS）、Zung氏焦虑自评量表（SAS）及癌症患者生活质量核心问卷（QLQ‐C30）评分。结果护理后,试验组患者SAS、SDS评分明显低于对照组;试验组患者总体生存质量明显高于对照组,差异均有统计学意义（P＜0．05）。结论对妇科肿瘤化疗患者给予综合护理干预,可有效改善患者心理状况和生活质量,值得临床推广使用。     

The impact of chemotherapy-induced nausea and vomiting on health-related quality of life

Goal of work The objectives of this prospective observational study were to estimate the frequency of patients who reported an impact of chemotherapy-induced nausea and vomiting (CINV) on their daily life and to evaluate the determinants of such an impact. Materials and methods Adult cancer patients at seven Italian oncology centers who were receiving cisplatin-containing regimens reported incidence and intensity of CINV for eight consecutive days in a diary and completed a Functional Living Index for Emesis (FLIE) questionnaire. Main results Overall, 34% of patients reported vomiting and 62% reported nausea after chemotherapy. On days 1 to 5 after receiving chemotherapy, 67% of patients who had at least one emetic episode and 77% of those who suffered from at least mild nausea experienced an impact on their daily activities as measured on the FLIE questionnaire. More than 90% of all patients with both acute and delayed nausea or vomiting reported an impact on their daily life. Both acute and delayed vomiting contributed in similar measure to impact daily life; however, the importance of delayed nausea was greater than that of acute nausea. Conclusions Despite antiemetic prophylaxis, CINV is still prevalent and often impacts the daily life of patients in Italy, especially in the delayed phase. The duration more than the severity seems to be responsible for the impact of CINV on the patients’ daily lives.     

穴位按摩联合艾灸减轻妇科腹腔镜术后患者恶心呕吐的效果

目的探讨穴位按摩联合艾灸内关穴、足三里穴、中脘穴在减轻妇科腹腔镜术后患者恶心呕吐的效果。方法将120例妇科腹腔镜手术患者随机分为干预组和对照组,每组各60例。对照组给予常规护理,干预组在常规护理基础上配合一套穴位按摩联合艾灸护理。术后采用WHO术后恶心呕吐的评定标准,对两组患者的恶心呕吐情况进行评价。结果两组比较,恶心呕吐程度对照组强于干预组(P0.05或P0.01)。结论以穴位按摩联合艾灸,并将健康教育贯穿其中的护理模式,能有效缓解妇科腹腔镜术后患者的恶心呕吐,安全方便易行。     

化疗后恶心呕吐防治的研究进展

文章指出了现代医学对恶心呕吐的认识及化疗后恶心呕吐的发生机制,并从药物、葡萄汁、音乐疗法及肌肉放松疗法、芳香疗法、耳穴压豆、针灸、穴位按摩、中药汤剂等方面对国内外化疗后恶心呕吐的研究进展进行综述,以期对临床的防治工作提供实证依据。     

Anticipatory nausea and vomiting: A review of psychological interventions

Although a cure for cancer continues to elude scientists, modern chemotherapy treatments can typically reduce or reverse the rate of disease progression and can often lead to restored health. However, chemotherapy can also produce severe, sometimes intolerable, side effects. A particularly distressing and aversive side effect that develops in 25 to 32% of all chemotherapy patients is anticipatory nausea and vomiting (ANV). Fortunately, research investigating the prevalence, etiology, predictors, and treatment of ANV has flourished since the early 1980s, and there has been significant progress in understanding this phenomenon. Although antiemetic medications appear to be ineffective in controlling ANV, several psychological interventions, including progressive muscle relaxation training, systematic desensitization, hypnosis, attentional distraction, and stimulus control have produced promising results. The present paper is a review of these interventions.     

耳穴埋籽结合心理疏导对癌症化疗患者疗效、生活质量及负性情绪影响的研究

[摘要]目的 探讨耳穴埋籽结合心理疏导应用于癌症化疗患者中对恶心呕吐及生活质量的影响。方法 选取2019年8月至2020年8月收治的癌症化疗患者96例,随机分为两组,各48例。对照组实施常规干预,观察组在对照组基础上实施耳穴埋籽结合心理疏导,比较两组治疗效果、生活质量与负性情绪。结果 观察组干预后治疗效果优于对照组（P＜0.05）;观察组干预后生活质量高于对照组（P＜0.05）;观察组干预后负性情绪轻于对照组（P＜0.05）。结论 耳穴埋籽结合心理疏导应用于癌症化疗患者中可有效缓解其恶心、呕吐症状,提高其生活质量,缓解负性情绪。     

The cost of chemotherapy-induced nausea and vomiting in Italy

Goals of work The aim of this paper is to analyze the costs of chemotherapy-induced nausea and vomiting (CINV) in Italy. Materials and methods In this prospective observational study at seven public oncology centers, incidence and intensity of CINV daily for 8 days after chemotherapy in consecutive patients receiving cisplatin-containing chemotherapy were recorded. All costs related to CINV (direct medical, direct nonmedical, and indirect) were recorded (in 2003 euros). Main results A total of 172 patients were enrolled; cost data were available for 168 patients. Thirty-seven percent of patients experienced acute CINV, and 57% experienced delayed CINV; 39% achieved total control, defined as no nausea, vomiting, or rescue therapy. Mean per-patient costs of acute and delayed CINV were €30.03 from the hospital perspective, €4.9 from the patient perspective, and €26.85 from the National Health Service (NHS) perspective. Costs of CINV were highly variable among oncology centers, largely because of differences in procedures for preventing delayed CINV. These costs were four times higher when antiemetic drugs were prescribed and paid for by the NHS than when antiemetic prophylaxis was provided directly from hospital pharmacies. Moreover, in the delayed phase, the NHS incurred a 94% increase in costs for patients without total control. Overall costs for patients who did not experience total control of CINV were €35.57 higher than for those who did (85% increase). Conclusions Costs of CINV for the Italian NHS could be reduced if hospitals furnished antiemetic prophylaxis directly to patients. Better control of both acute and delayed CINV would improve patient well-being as well as reduce the budgetary impact of CINV in Italy.     

营养状况对肺癌化疗患者所致恶心呕吐的影响

目的 探讨营养状况对以顺铂为基础化疗的肺癌患者所致化疗相关性恶心呕吐（CINV）的影响。方法 选取常州市第一人民医院采用顺铂化疗的肺癌住院患者200例,均选用昂丹司琼作为止吐药物,根据营养评定量表（PG SGA）评分分为营养不良组,无营养不良组,分析两组临床资料、营养相关指标、CINV。对存在营养不良的患者进行营养干预,比较营养干预前后CINV持续时间。结果 纳入的200例患者中PG SGA评分≥4分122例,61%的患者存在营养不良。两组性别、年龄、肿瘤类型、肿瘤分期、化疗方案等临床资料差异均无统计学意义(P＞0.05）。多因素回归分析营养不良是CINV的独立危险因素。对存在营养不良的患者进行营养干预后,恶心呕吐持续时间较前改善（P＜0.01）。结论 营养不良是CINV的独立危险因素,进行营养干预可改善CINV持续时间。     

甲孕酮在预防化疗消化道反应中的作用

目的:比较恩丹西酮+地塞米松、恩丹西酮+地塞米松+甲孕酮(倍恩胶囊)二种止吐方案预防化疗消化道反应的疗效。方法:以顺铂或蒽环类为主化疗的患者80例,随机分为两组,每组40例,分别用上述止吐方案,观察化疗当日至化疗第4 d预防消化道反应的效果。结果:二种止吐方案对控制呕吐有效率相近,对控制恶心二种方案在第1,2 d有效率有显著差异(P<0.05),对减轻食欲不振二种方案有效率有极显著差异(P<0.01)。结论:恩丹西酮+地塞米松能很好地控制化疗所致恶心、呕吐,加用甲孕酮后疗效有所提高,特别是减轻食欲不振疗效明显优于恩丹西酮+地塞米松。     

Acupuncture and acupressure for the management of chemotherapy-induced nausea and vomiting

PURPOSE: To review existing research, the National Institutes of Health (NIH) consensus statement, and federal regulations regarding the use of acupuncture and acupressure in the management of chemotherapy-induced nausea and vomiting in order to give nurse practitioners (NPs) the information they need to provide the best care for patients undergoing chemotherapy treatment for cancer. DATA SOURCES: Selected scientific literature and Internet sources. CONCLUSIONS: Research supports the effectiveness of acupuncture and acupressure for the treatment of chemotherapy-induced nausea and vomiting. Used in conjunction with current antiemetic drugs, acupuncture and acupressure have been shown to be safe and effective for relief of the nausea and vomiting resulting from chemotherapy. IMPLICATIONS FOR PRACTICE: Even with the best antiemetic pharmacological agents, 60% of cancer patients continue to experience nausea and vomiting when undergoing chemotherapy treatments. Because the NIH supports the use of acupuncture for nausea and vomiting, the NP is obligated to be knowledgeable about the use of these and other effective complementary treatments in order to provide the best care.     

Anticipatory nausea and vomiting: broadening the scope of psychological treatments

Anticipatory nausea and vomiting, as a sideeffect of cancer chemotherapy, is a well-recognised phenomenon known to affect a substantial minority of patients. Although explicable using a conditioning model, it may have a complex aetiology with affective and cognitive elements as well as specific pharmacological factors playing a role in its onset and maintenance. It is amenable to treatment using psychological techniques but to treat successfully it is important to understand the aetiology and formulate treatment plans according to those factors that make a significant contribution to the cause. It is suggested here that a behavioural model provides an over-simplistic conceptualisation and that cognitive factors play a central role in onset. As such, treatment plans need to be broader in scope by focusing on a range of strategies to enhance coping and particularly cognitive coping techniques. More recently there has also been some indication that psychological factors may contribute to symptoms of nausea and comiting occurring during or after chemotherapeutic infusion. Should this effect be replicated, the scope for psychological treatments within the care of patients receiving chemotherapy would be widened.Presented as an invited lecture at the 4th International Symposium: Supportive Care in Cancer, St. Gallen, Switzerland, 24–27 February 1993