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：     

恶性肿瘤化疗引起恶心呕吐的护理

近年来化疗己成为恶性肿瘤最主要的治疗手段。我们知道，化疗药物有“细胞毒”和促进分化等作用，可以杀死癌细胞，抑制癌细胞生长繁殖和促进癌细胞的分化等，从而达到治疗或治愈肿瘤之目的。但是进入肿瘤组织内的化疗药物浓度与其他正常组织没有明显的差别，容易对全身各器官组织造成损害，引起全身化疗毒副反应。     

化疗病人恶心呕吐的护理

化学治疗（简称化疗）是恶性肿瘤病人的主要治疗手段之一。但由于化疗药物的副作用大、毒性强，特别是化疗过程中产生的恶心呕吐，常可引起脱水、电解质代谢紊乱，使病人感到极大的痛苦，严重影响病人的生活质量。因此，为了减轻化疗所至的恶心呕吐等胃肠道反应，我们通过围绕化疗前、中、后期采取积极的预防和护理，严密观察化疗药物的副作用，正确使用止吐药等具体护理措施，取得了良好的临床效果，现介绍如下。     

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。     

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。     

护理干预对减轻癌症化疗患者恶心呕吐效果观察

目的：探讨护理干预预防和减轻癌症化疗患者恶心呕吐的效果。方法：对50例化疗患者进行了系统的护理干预,并与50例常规护理进行对照。结果：护理干预组较对照组发生恶心呕吐明显减少,程度明显减轻,两组比较差异有显著性（P〈0．05）。结论：护理干预可明显减轻化疗患者的恶心呕吐症状,减轻患者的痛苦。     

健康教育对肿瘤化疗患者恶心呕吐的作用

化学药物仍是当今抗癌治疗的主要手段之一,但化疗引起的恶心呕吐常使患者感到难以忍受,拒绝接受进一步化疗,影响了对疾病的控制。健康教育作为一种辅助性治疗手段[1] ,能显著减轻肿瘤化疗患者恶心呕吐的发生。2 0 0 2年1月至2 0 0 3年6月我院对4 3例化疗患者实施了全面而系统的     

护理干预减轻化疗所致恶心呕吐的探讨

目的：探讨减轻化疗所致恶心呕吐的护理方法。方法：对40例癌症化疗患者进行了系统的护理干预，并与40例常规护理进行对照。结果：系统护理干预组与常规护理组差异有高度显著性（p〈0．001）。结论：护理干预无副作用，患者可在轻松愉快中得到治疗．并增进了护患之间的合作与信任。     

社区癌症化疗患者恶心呕吐的护理

为降低患者化疗期间恶心呕吐的发生率,提高患者的生活质量,总结了社区癌症化疗患者恶心、呕吐的护理.主要包括为癌症化疗患者建立社区健康档案.化疗前后采取积极的预防及护理干预,化疗前作好护理评估,了解化疗经过,熟悉化疗方案,给予适当的饮食指导、心理疏导;化疗期间观察其不良反应并做好记录;化疗后随访跟踪等.认为社区系统的护理干预措施有利于缓解社区癌症化疗患者的恶心呕吐,有利于提高癌症患者生活质量,值得推广.     

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。     

Acupressure for nausea and vomiting in cancer patients receiving chemotherapy

Practitioners working with patients undergoing chemotherapy regularly encourage them to use acupressure in the form of Sea Bands for the relief of treatment-related nausea and vomiting. This mini-review sets out to uncover and examine the evidence base for this recommendation. A mini systematic review was carried out to identify randomized controlled trials comparing the use of acupressure plus usual care with usual care alone. The population was adult patients receiving cancer chemotherapy. The outcome was nausea or vomiting duration or intensity. Searches on Medline, Embase, AMED, the Cochrane Library, Cancerlit and Cinahl identified two randomized controlled trials involving 482 patients with compared acupressure to no intervention control. The results suggest that acupressure may decrease nausea among patients undergoing chemotherapy but further work is required before conclusively advising patients on the efficacy of acupressure in preventing and treating chemotherapy-induced nausea.     

Examining racial variation in antiemetic use and post-chemotherapy health care utilization for nausea and vomiting among breast cancer patients

Purpose

Racial minority cancer patients may experience underuse of antiemetic medications to prevent chemotherapy-induced nausea and vomiting (CINV). In addition to its adverse implications for quality of life, antiemetic underuse may contribute to observed disparities in acute illness during chemotherapy. To understand the potential contribution of CINV prophylaxis to breast cancer disparities, we assessed racial variation in potent antiemetic use and post-chemotherapy utilization related to CINV and the relationship between the two.

Methods

We used SEER-Medicare data to evaluate the health care utilization in the 14 days following chemotherapy initiation among black and white women receiving highly emetogenic chemotherapy for breast cancer. We used modified Poisson regression to assess the relationship between (1) race and CINV-related utilization and (2) NK1 use and CINV-related utilization, overall and stratified by race. We report adjusted risk ratios (aRR) and 95 % confidence intervals (CI).

Results

The study included 1130 women. Black women were 11 % less likely than white women to use neurokinin-1 receptor antagonists (NK1s) for CINV prophylaxis (p = 0.02); however, they experienced fewer CINV-related encounters following chemotherapy (unadjusted RR = 0.63, 95 %CI = 0.40–0.99; p = 0.05). After adjustment for clinical covariates, estimates were similar but no longer statistically significant (p = 0.07). Among white women, NK1 use was associated with increased CINV-related utilization (aRR NK1 users vs. non-users: 1.35, 95 % CI = 1.07–1.69, p = 0.01), likely resulting from unmeasured confounders.

Conclusion

Black women were less likely to use NK1s- and CINV-related services. Racial variation in CINV-related services use may be partly explained by differential symptom reporting or access to care.

     

分级管理方案在乳腺癌患者化疗所致恶心呕吐中的应用

目的 探讨分级管理方案在乳腺癌患者化疗所致恶心呕吐（chemotherapy induced nausea and vomiting,CINV）中的应用效果。方法 采取整群抽样法抽取试验组及对照组各158例,试验组给予CINV分级管理方案,对照组给予CINV常规护理,比较两组CINV发生情况及CINV对生活质量的影响。 结果 试验组接受高度、中度致吐风险化疗方案的患者,CINV发生情况明显低于对照组（P<0.05）,而接受低度致吐风险化疗方案的两组患者,CINV发生情况差异无统计学意义（P>0.05）;试验组接受高度、中度及低度致吐风险化疗方案的患者,呕吐生活功能指数量表评分均明显高于对照组（P<0.05）。 结论 CINV分级管理方案总体上可降低CINV的发生率及等级,并降低CINV对患者生活质量的影响。     

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.     

护理干预对乳腺癌化疗病人恶心呕吐的影响

[目的]探讨护理干预对减轻乳腺癌化疗病人恶心呕吐的影响.[方法] 随机将320例化疗病人分为对照组120例和观察组200例,对照组给予化疗常规护理,观察组在此基础上给予科学的护理干预.[结果]观察组恶心呕吐发生率及发生程度均显著低于对照组(P<0.05),两组病人化疗前后焦虑自评量表(SAS)评分比较,差异有统计学意义(P<0.01).[结论]科学的护理干预,可明显减轻化疗病人恶心呕吐症状和焦虑心理,减轻痛苦,提高生活质量.