Anticipatory nausea and vomiting

Anticipatory nausea and vomiting (ANV) is not only a learned response but can occur without prior exposure to chemotherapy depending on patient emotional distress and expectations. The best method to avoid development or reinforcement of ANV is to avoid both vomiting and nausea from the first exposure to chemotherapy. If ANV develops, benzodiazepines have been documented to help in adult patients, and several psychological techniques are also of help, including systematic desensitization. The evidence on which these conclusions are based is reviewed in this article.     

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.     

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。     

渐进式肌肉放松训练对乳腺癌高致吐方案化疗所致恶心呕吐的效果观察

目的 探讨渐进式肌肉放松训练对乳腺癌高致吐方案化疗所致恶心呕吐(CINV)的治疗效果。方法 收集我院2017年1月-2017年6月行表阿霉素联合环磷酰胺(EC)方案化疗的乳腺癌患者68例,按照随机数字表法分为观察组和对照组,每组各34例。对照组给予托烷司琼注射液、地塞米松治疗;观察组在此基础上进行渐进式肌肉放松训练,比较两组对预防CINV的临床疗效。结果 急性期两组恶心、呕吐发生率、恶心缓解率及呕吐频次比较,差异均无统计学意义(P>0.05);延迟期两组恶心发生率比较,差异无统计学意义(P>0.05),观察组呕吐发生率、呕吐频次明显低于对照组,恶心缓解率明显高于对照组,差异有统计学意义(P<0.05)。结论 渐进式肌肉放松训练能显著降低乳腺癌高致吐方案化疗延迟期呕吐发生率、呕吐频次和恶心程度,简便易行,可用于临床防治乳腺癌高致吐方案化疗所致CINV。     

护理干预对控制癌症化疗患者恶心和呕吐的作用

目的探讨护理干预对控制癌症化疗患者恶心、呕吐的作用。方法将2008年6月-2009年1月收治的206例接受化疗癌症患者随机分为干预组（103例）和对照组（103例）,化疗前后均给予患者盐酸格拉司琼止吐。干预组在化疗前、化疗中、化疗后对患者进行护理干预,对照组只进行一般护理。结果干预组患者0级、Ⅰ级、Ⅱ级恶心、呕吐发生率明显低于对照组,两组比较,差异具有统计学意义（P〈0．05）;干预组对护理干预效果满意度明显优于对照组,两组比较,差异具有统计学意义（P〈0．05）。结论护理干预可降低化疗患者恶心、呕吐发生率,确保化疗顺利完成,减轻了患者的痛苦,提高了患者对护理服务的满意度。     

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。     

Aprepitant in antiemetic combinations to prevent chemotherapy-induced nausea and vomiting

Aprepitant is an oral neurokinin-1 receptor antagonist which acts centrally to block chemotherapy-induced emesis. Its main pathway of elimination is by the cytochrome p450 isozyme CYP3A4, which is the basis for drug interactions with dexamethasone and oral contraceptives. Aprepitant is well tolerated, and phase II trials in high-dose cisplatin-induced emesis showed that it is most effective when 125 mg orally is added to a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone for acute emesis and then an 80 mg oral dose continued with dexamethasone on days 2 and 3 to prevent delayed emesis. Two pivotal phase III trials enrolling a total of 1099 patients showed that the complete control of emesis improved by 20% in patients receiving aprepitant as compared with standard therapy, with the most impressive differences being in delayed emesis. Control was maintained over multiple cycles and occurred in both males and females and young and old adults.     

The management of post-operative nausea and vomiting

Despite the advent of new technology and pharmacological agents, post-operative nausea and vomiting (PONV) continues to have an incidence of 20-30% today. Development of PONV can lead to serious complications such as aspiration, dehydration, electrolyte disturbances and disruption of the surgical site. PONV leads to increased cost of treatment, and may be associated with increased anxiety, dissatisfaction with the surgical experience and anticipatory nausea in the future. The mechanisms of PONV are examined with associated risk factors. A review of the literature of PONV management is included covering pharmacological, dietary and behavioural interventions; culminating in the development of assessment and management guidelines and identification of areas for further study.     

化疗病人恶心呕吐的护理

从恶心呕吐的定义、恶心呕吐对机体的影响、引起恶心呕吐的相关因素等方面综述了化疗病人的护理．目的在于提高化疗病人的生活质量。     

化疗病人恶心呕吐的护理

从恶心呕吐的定义、恶心呕吐对机体的影响、引起恶心呕吐的相关因素等方面综述了化疗病人的护理,目的在于提高化疗病人的生活质量。     

Cost-effectiveness analysis of aprepitant in the prevention of chemotherapy-induced nausea and vomiting in Belgium

OBJECTIVES: Chemotherapy-induced nausea and vomiting (CINV) remains a major adverse effect of cancer chemotherapy which may increase morbidity, reduce quality of life and threaten the success of cancer therapy. Aprepitant is effective in preventing CINV, achieving higher complete response (no emesis and no rescue therapy) compared to standard prevention, in patients receiving either highly (HEC) or moderately emetogenic chemotherapy (MEC; absolute reduction = 11 and 13%, respectively). We assessed the cost effectiveness of aprepitant-based vs standard prevention in these indications in Belgium. MATERIALS AND METHODS: A decision analytical model was developed in MS Excel (Fig. 1). To estimate resource use, two approaches were used. The first is based on the preventive regimens applied in randomized controlled trials comparing aprepitant-based CINV prevention (for HEC: aprepitant days 1-3, ondansetron 32 mg i.v. day 1, oral placebo twice daily days 2-4, oral dexamethasone days 1-4; for MEC: aprepitant days 1-3, ondansetron 16 mg p.o. day 1, placebo on days 2-3, oral dexamethasone day 1), vs a standard regimen (for HEC: oral placebo days 1-3, ondansetron 32 mg i.v. day 1 and 16 mg p.o. days 2-4, oral dexamethasone days 1-4; for MEC: oral placebo, ondansetron 16 mg p.o. days 1-3, dexamethasone day 1) The second analysis is based on current real-world resource use in the Belgian setting in the prevention of CINV using a longitudinal Hospital Database. CINV-specific utility values were used to calculate quality-adjusted life years (QALYs). Drug costs were obtained from official reimbursement listings. Treatment costs for CINV were obtained from a German study and adapted to Belgium. RESULTS: The aprepitant-based regimen is associated with 0.003 and 0.014 more QALYs in HEC and MEC, respectively and with per patient savings of 66.84 (trial based) and 74.62 (real-life based) for HEC and 17.95 (trial based) and 21.70 (real-life based) for MEC. Hence, aprepitant is both more effective and less expensive (=dominant). One-way sensitivity analyses were performed on treatment cost of emesis, the clinical benefit of aprepitant and the cost of ondansetron and showed that the results were robust on the first two parameters but sensitive on the decrease in cost of ondansetron for the moderately emetogenic chemotherapy regimens. CONCLUSIONS: In both approaches, the aprepitant-based strategy is more effective and less expensive compared to standard care.     

耳穴压豆联合昂丹司琼改善宫颈癌术后化疗患者恶心、呕吐反应发生情况的效果

目的探究耳穴压豆联合昂丹司琼改善宫颈癌术后化疗患者恶心、呕吐反应发生情况的效果。方法选取我院2016年2月至2019年2月的宫颈癌术后化疗患者80例,按照随机数字表法将其分为对照组和观察组,各40例。对照组给予昂丹司琼治疗,观察组给予耳穴压豆联合昂丹司琼治疗。比较两组疗效、呕吐次数、恶心等级、恶心及呕吐反应缓解时间及化疗应激指标。结果第1天,两组的治疗总有效率无显著差异(P>0.05);第2、3、4天,观察组的治疗总有效率均显著高于对照组(P<0.05)。第2、3、4天,观察组的呕吐次数、恶心等级均优于对照组(P<0.05);第2、3、4天,观察组的呕吐次数、恶心等级均优于第1天(P<0.05)。观察组的恶心、呕吐反应缓解时间均显著短于对照组(P<0.05)。观察组的胰岛素水平高于照组,空腹血糖水平、HAMA评分、NRS及HAMD均低于对照组(P<0.05)。结论耳穴压豆联合昂丹司琼治疗可降低宫颈癌术后化疗患者的恶心、呕吐反应发生率,促进恶心与呕吐反应缓解,改善化疗应激指标。     

格拉司琼预防小儿腹腔镜手术后恶心呕吐

目的观察格拉司琼预防全麻下小儿腹腔镜手术后恶心呕吐的临床效果。方法选择80例ASAⅠ～Ⅱ级行择期全麻下腹腔镜手术的患儿,年龄2～10岁,随机分为两组,每组40例。对照组(C组)给予生理盐水5 ml;格拉司琼组(G组)给予格拉司琼40μg/kg,两组均于手术结束时静脉注射,观察24 h内患儿发生恶心呕吐的次数,计算呕吐率。结果术后恶心呕吐发生率对照组(C组)明显高于格拉司琼组(G组),差异有统计学意义(P0.01)。结论格拉司琼能有效减少小儿腹腔镜手术后的恶心呕吐。     

小柴胡汤合蒿芩清胆汤治疗化疗所致恶心呕吐的临床疗效

目的探讨对化疗后恶心呕吐患者采用小柴胡汤合蒿芩清胆汤治疗的临床疗效。方法选择80例化疗后恶心呕吐患者进行观察,采用随机数字表法将患者分为研究组和对照组,各40例。对照组运用阿瑞匹坦治疗,研究组采用蒿芩清胆汤、小柴胡汤联合治疗。治疗1周,观察2组治疗效果。随访2周,观察2组恶心呕吐症状改善情况及食欲恢复情况。结果研究组治疗总有效率、食欲恢复正常患者比例显著优于对照组,比较差异有统计学意义(P0.05)。结论化疗后恶心呕吐患者采用蒿芩清胆汤、小柴胡汤联合治疗的疗效安全可靠,患者的耐受性好。在改善患者恶心呕吐症状的同时保护胃肠道功能,增强食欲,提高患者的营养状况。     

Diphenhydramine for nausea and vomiting related to cancer chemotherapy with cisplatin

High dose metoclopramide and adjuvant drugs, such as corticosteroids, benzodiazepines, and drugs with antidopaminergic, anticholinergic, or antihistaminic effects, are the most widely used antiemetics in cancer patients receiving chemotherapy, particularly cisdichloro-diammine platinum II (cisplatin). The purpose of our prospective randomized study was to investigate the possible antiemetic efficacy of diphenhydramine as an adjuvant antiemetic drug when combined with metoclopramide (MCP). A total of 91 patients were assigned to either group A (N = 44) who received only MCP and group B (N = 47) who received the combination of MCP and diphenhydramine. All patients received cisplatin-based combination chemotherapy for the first time and were evaluated only once in order to exclude the effects of anticipatory nausea and vomiting. There were no statistically significant differences between the two groups except that patients treated with diphenhydramine presented more sedative effects and had more limited activity. Also diphenhydramine did not give absolute protection from the extrapyromidal side effects of MCP. Side effects of diphenhydramine were minimal and well tolerated. We conclude that diphenhydramine is not a useful adjuvant drug in the antiemetic therapy.     

Patient-controlled antiemesis for cancer chemotherapy-induced nausea and vomiting

Nausea and emesis during cancer chemotherapy are very common, but can often be controlled with repetitive boli of antiemetic drugs. However, some patients, especially those with anticipatory symptoms, experience nausea and emesis despite antiemetic prophylaxis. An increased participation of these patients in the prophylaxis and treatment of these highly subjective symptoms may lead to better palliation. A patient controlled infusion pump was assessed in nine patients receiving cisplatin, in whom high-dose metoclopramide (5 mg/kg) had failed (>3 emetic episodes) during previous treatment cycles. Improved palliation was achieved in every case with on-demand boli in combination with a continuous infusion of metoclopramide or droperidol. Eight of the nine patients preferred the patient-controlled system to the conventional fixed-dose bolus regimens. The infusion pump functioned safely and reliably. Antiemetic treatment with the patient-controlled device was superior to previous conventional methods in this group of diffcult-to-treat patients.     

抗肿瘤化疗药物所致恶心呕吐的护理干预

报道了对637例癌症患者化疗所致恶心、呕吐的护理，包括正确评估恶心、呕吐症状，选择最佳给药途径和给药时间，加强饮食护理，鼓励患者散步和足底按摩，科室积极开展群体性娱乐活动，为患者提供生理、心理舒适护理等。     

ABC情绪管理在预期性呕吐患者中应用

目的探讨发生预期性恶心、呕吐的患者在化疗期间的应对方式,通过ABC情绪管理,改善患者情绪状态及应对方式,为今后的心理护理给予指导。方法以30名发生预期性恶心、呕吐患者为研究对象,运用焦虑、抑郁自评量表及简易应对问卷测量患者的情绪及应对方式,运用ABC情绪管理对预期性恶心、呕吐的患者进行干预,形式为集体培训与沙龙交流,内容包括化疗与情绪的关系、ABC情绪机制、有关疾病及化疗相关知识、应对不良情绪的技巧及不良情绪自我分析。结果预期性恶心、呕吐的患者在情绪管理后焦虑、抑郁得分显著下降,恶心呕吐程度显著下降,应对方式在干预后,积极应对方式评分明显提高,差异有显著意义(P<0.05)。结论 ABC情绪管理有助于改良预期性呕吐患者的应对方式,改善患者的不良情绪,提高生活质量。     

Olanzapine as an antiemetic in refractory nausea and vomiting in advanced cancer

Nausea and vomiting are difficult symptoms to manage in patients with advanced cancer. Several classes of antiemetics are available, including phenothiazines, butyrophenones, substituted benzamides and selective serotonin antagonists, as well as corticosteroids. Most patients will respond to either single agents or combinations that frequently include corticosteroids. A minority of patients will have nausea that fails to respond. The atypical antipsychotic, olanzapine, relieves nausea in some patients failing to respond to the usual antiemetics. Two case reports are presented and the rationale for olanzapine's benefit is discussed.     

按揉背俞穴减轻化疗后病人恶心与呕吐的研究

[目的]观察按揉背俞穴对化疗后病人恶心、呕吐发生频率和程度的影响。[方法]选取2011年1月—2012年6月在本院肿瘤外科及妇科住院行化疗且方案中使用铂类药物的60例病人,皆签署知情同意书愿意配合本研究,采用随机数字表分为两组,对照组和试验组各30例,对照组行常规护理,试验组在对照组基础上予病人按揉背俞穴,观察两组病人恶心、呕吐、干呕发生的频率和程度。[结果]化疗后两组病人恶心、呕吐、干呕发生的频率和程度比较差异有统计学意义(P0.01)。[结论]按揉背俞穴能减轻化疗后病人恶心、呕吐、干呕发生的频率和程度。