渐进性肌肉放松训练与药物在化疗所致恶心呕吐中应用的比较研究

目的 探讨渐进性肌肉放松训练(PMRT)和引导意想疗法在胃肠道恶性肿瘤化疗所引起恶心和呕吐中的作用.方法 以120例接受FOLFOX方案化疗的胃肠道恶性肿瘤患者为研究对象,分别采用PMRT和引导意想疗法、凯特瑞和胃复安治疗化疗所致的恶心和呕吐,观察其效果,并进行效果分析.结果 急性呕吐组三者防治恶心、呕吐的平均有效率分别为63.6%、90.9%和27.3%;延迟性呕吐组三者防治恶心、呕吐的平均有效率分别为77.8%、33.3%和22.2%,急性呕吐组中PMRT和引导意想疗法与凯特瑞的疗效差异有统计学意义(P＜O.05),凯特瑞与胃复安的疗效有明显的统计学差异;延迟性呕吐组中PMRT和引导意想疗法与凯特瑞、胃复安的疗效有明显的统计学差异,凯特瑞与胃复安的疗效差异无统计学意义.结论 PMRT和引导意想疗法对化疗药物所致的恶心、呕吐有一定的疗效;凯特瑞能有效预防化疗药物所致的急性恶心、呕吐,对延迟性恶心、呕吐有部分疗效;胃复安预防化疗药物所致的恶心、呕吐的效果较差.PMRT和引导意想疗法是肿瘤化疗安全、有效、经济的方法之一.     

放松训练对患者化疗后恶心呕吐的干预

恶心呕吐是肿瘤患者化疗常见的并发症，常可导致严重后果，增加患者痛苦、降低患者对化疗的依从性。因此，2004年1月-2005年10月，我们将在本院肿瘤科住院的70例化疗方案相同的患者分成治疗组和对照组，对治疗组患者进行放松训练干预，改善其焦虑、抑郁状态，以探讨放松训练对化疗患者恶心呕吐程度的影响，现报道如下。     

2种止吐方案预防乳腺癌化疗所致恶心呕吐的费用效果分析

化疗是肿瘤病人重要的治疗措施之一。病人一方面要面对化疗药引发的恶心、呕吐等消化道反应；另一方面要面对不菲的医疗费用。因此，医务工作者在选择治疗方案时，应主动为病人考虑药物效价比，使病人以较小的经济负担得到最佳的治疗效果。为了对比观察2种止吐方案的药物效价比，2004年1月—2004年9月，我们对乳腺中心接受门诊化疗的80例病人进行了随机分组，采用交叉自身对照研究。并用药物经济学方法对两种方案进行了成本—效果分析，现将结果报告如下。     

渐进式肌肉放松训练在癌症患者中的应用进展

该文从渐进式肌肉放松训练的来源与基础、实施过程、在癌症患者中的应用现状及作用进行综述,探讨渐进式肌肉放松训练的干预效果,并归纳与总结目前研究中存在的问题,提出对未来的展望,以便为癌症患者制订合理的渐进式肌肉放松训练方案提供参考依据。     

穴位敷贴配合昂丹斯琼在治疗乳腺癌CEF化疗方案所致恶心呕吐的临床观察

目的 观察穴位敷贴配合昂丹斯琼在治疗乳腺癌CEF化疗方案所致呕吐的临床效果。方法 随机选取采用CEF化疗方案(环磷酰胺、表柔比星、氟尿嘧啶)的乳腺癌患者100例,随机分为试验组和对照组,每组各50例,两组患者均在化疗前30分钟给予静脉注射昂丹斯琼8mg,试验组在化疗前予内关(双侧)和足三里(双侧)贴穴位敷贴, 记录化疗起4小时、8小时、 24h恶心呕吐程度,进行疗效观察。结果 试验组控制呕吐的有效率明显高于对照组(P<0.05)。结论 艾穴位敷贴配合盐酸昂丹斯琼治疗乳腺癌CEF化疗方案所致呕吐疗效好、易于操作、使用安全。     

帕洛诺司琼预防高致吐性化疗所致恶心呕吐临床研究

目的:通过帕洛诺司琼和格拉司琼分别联合地塞米松预防以大剂量顺铂为主方案化疗所致恶心呕吐,观察和评价帕洛诺司琼联合地塞米松预防高致吐性化疗方案的疗效和安全性.方法:56例非小细胞肺癌患者接受以大剂量顺铂为主化疗方案,随机分为两组:治疗组28例,对照组28例.治疗组:帕洛诺司琼0.25 mg,静脉推注;对照组:格拉司琼3 mg,静脉滴注;两组均联合地塞米松12 mg,静脉推注,均于化疗前30min给药.结果:治疗组和对照组预防急性呕吐的完全有效率分别为82.1%和78.6%,恶心的改善率分别为64.3%和60.7%,差异均无显著性(P>0.05);治疗组和对照组预防延迟性呕吐的完全有效率分别为60.7%和39.3%,差异有显著性(P<0.05).结论:帕洛诺司琼和格拉司琼分别联合地塞米松预防以大剂量顺铂为主方案化疗所致急性呕吐和恶心疗效相当,对于延迟性呕吐的完全有效率前者优于后者,不良反应轻,患者耐受性良好,推荐帕洛诺司琼联合地塞米松作为高致吐性化疗方案的常规药物.     

托烷司琼预防乳腺癌化疗中恶心呕吐的疗效观察

目的:观察托烷司琼在预防乳腺癌化疗所致恶心呕吐的临床疗效。方法:将46例接受环磷酰胺、吡柔比星、5氟脲嘧啶联合化疗的乳腺癌患者进行4~6个疗程的自身对照,随机分为托烷司琼组和恩丹西酮组,比较治疗效果。结果:托烷司琼组与恩丹西酮组止吐疗效比较有显著性差异(P<0.05)。两组的不良反应无明显差异。结论:托烷司琼能有效控制恶性肿瘤化疗所致的恶心呕吐,且不良反应少,可作为预防化疗引起的恶心呕吐的优选药物,值得临床应用。     

正念减压配合渐进式肌肉放松训练对肺癌化疗患者护理效果分析

目的 探讨正念减压(MBSR)配合渐进式肌肉放松训练对肺癌化疗患者的护理效果.方法 抽取2017年6月至2019年5月间于江南大学附属医院确诊并接受同种化疗方案的肺癌患者112例作为研究对象,按照双色球法随机分为两组各56例.对照组化疗期间行常规护理,研究组在常规护理基础上行MBSR配合渐进式肌肉放松训练干预,连续干预...     

肌肉放松训练对乳腺癌患者围手术期生活质量的影响

目的探讨渐进性肌肉放松训练对围手术期乳腺癌患者抑郁、焦虑和生活质量的影响。方法选取西安市两所综合三级甲等医院围手术期的乳腺癌患者200名为研究对象,将其随机分为观察组和对照组各100名,对照组患者给予常规护理,观察组患者在常规护理基础上进行5周的渐进性肌肉放松训练,采用乳腺癌患者生命质量测定量表(FACT-B)、抑郁自评量表(SDS)与焦虑自评量表(SAS),分别在入院第1天及干预后第5周后测评研究对象的生活质量和抑郁及焦虑变化情况。结果观察组患者经5周的肌肉放松训练后,生活质量得分、抑郁及焦虑评分较对照组患者有显著改善,差异有统计学意义(P0.05)。结论渐进性肌肉放松训练能有效改善围手术期乳腺癌患者的生活质量,缓解其抑郁与焦虑等不良心理状态,应广泛应用到乳腺癌患者的术后康复护理中。     

对肠易激综合征患者实施渐进性肌肉放松训练的效果观察

目的 观察渐进性肌肉放松训练对肠易激综合征患者的护理干预效果.方法 将60例肠易激综合征患者随机分为观察组和对照组各30例,对照组采用常规治疗及护理,观察组在此基础上,采用渐进性肌肉放松训练.结果 治疗12周后,观察组抑郁自评量表(SDS)评分(39.96±6.68)分,焦虑自评量表(SAS)的评分(38.9±2.53)分,显著低于对照组(P<0.01),肠道症状严重指数(1.93±0.63)、症状频率指数(2.73±0.75),均低于对照组(P<0.05).结论 渐进性肌肉放松训练能明显改善肠易激综合征患者的负性情绪、降低应激水平、减轻肠道症状,是一种有效的护理干预措施.     

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.     

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。     

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。     

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.     

渐进性肌肉放松训练对肺癌脑转移患者生活质量的影响

目的探讨渐进性肌肉放松训练对肺癌脑转移患者生活质量的影响。方法选取苏州大学附属第一医院2017年9月至2019年2月收治的80例肺癌伴脑转移患者为研究对象,采用随机数字表法分成两组。对照组(40例)患者给予常规护理;观察组(40例)实施常规护理+渐进性肌肉放松训练。观察两组患者脑卒中患者神经功能缺损评估量表(NIHSS)、生活质量量表评分及护理满意度的变化。结果护理干预前两组患者NIHSS及生活质量量表评分差异均无统计学意义(P>0.05)。干预6周后,两组患者NIHSS评分均呈不同程度降低,但对照组干预前后NIHSS评分差异无统计学意义(P>0.05),而观察组明显低于对照组及干预前(P<0.05);观察组生活质量量表评分除社会/家庭状况方面,其他方面评分均较干预前及对照组高(P<0.05);观察组护理满意度(95.0%)较对照组(80.0%)高(P<0.05)。结论渐进性肌肉放松训练有助于改善肺癌脑转移患者NIHSS评分及生活质量,提高护理满意度。     

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.     

Parents associated with children in measuring acute and delayed nausea and vomiting

The purpose of this study was to identify the relationship between parents and children in measuring children's acute and delayed nausea and vomiting induced by cancer chemotherapy. Twenty parent-child dyads participated in the study. Both instruments: Adapted Rhodes Index of Nausea and Vomiting by parent and by child (8-18 years old) were used every 12 h. The reliability and validity of these instruments have been established. There were significantly moderate to strong associations between parents and children in measuring these symptoms from Day 1 to Day 3 (total scores: r = 0.85-0.93; nausea scores: r = 0.67-0.93; and vomiting scores: r = 0.91-0.99, all P < 0.01). Therefore, parents' observation of their children's symptoms was strongly associated with their child's self-report of symptoms. Parents were able to assess their children's acute and delayed nausea and vomiting because in this sample almost all parents accompanied their children all day long.     

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。