乳腺癌化疗呕吐防治药物的应用评价

目的：评价乳腺癌化疗患者呕吐防治药使用的合理性。方法：以国际和中国呕吐防治药指南为标准，评价2014年9月~2015年4月94例乳腺癌化疗患者呕吐防治药应用的合理性，主要分析不同致吐风险级别，化疗的患者应用5-羟色胺3受体拮抗剂（5-HT3RA）及地塞米松等呕吐防治药的合理性。结果：92例（97.9%）患者使用5-HT3RA与指南推荐方案不符，其中63例（67.0%）帕洛诺司琼的给药频次偏高，80例（85.1%）重复使用5-HT3RA不合理，31例（33.0%）超致吐风险级别用药；61例（64.9%）使用地塞米松的剂量和疗程低于指南推荐方案。结论：乳腺癌化疗中呕吐防治药应用普遍存在不合理之处。预防化疗所致恶心呕吐，高、中致吐风险级别的患者，在化疗期间应通过增加地塞米松的剂量和疗程来避免过度使用5-HT3RA，低致吐风险级别的患者应单独使用5-HT3RA或地塞米松。通过将用药问题反馈给临床，有助于促进临床合理用药。

Evaluation of Drug Use in the Prevention and Treatment of Vomiting for Breast Cancer Patients Treated with Chemotherapy

Objective: To evaluate the rational use of anti-vomiting drugs during the chemotherapy in breast cancer patients. Methods: The use of antiemetic drugs was evaluated on the basis of international and Chinese antiemetic therapy guidelines in 94 patients of breast cancer treated with chemotherapy from September, 2014 to April, 2015. It was mainly analyzed for the rationality of using 5-hydroxytrptamin 3 receptor antagonist (5-HT3RA) and dexamethasone, et al in patients under chemotherapy at different emetic risk levels. Results: The 5-HT3RA using by 92 patients (97.9%) was inconsistent with the guidelines; The use frequency of palonosetron was too high in 63 patients (67%); The repeat use of 5-HT3RA in 80 pa-tients (85.1%) was unreasonable; 31 patients (33.0%) used antiemetic drugs unnecessarily over their risk levels; 61 patients (64.9%) used dexamethasone under the dose and course recommend by the guidelines. Conclusion: There exists a general phenomenon that the use of antiemetic drugs is not reasonable during chemotherapy in breast cancer patients. There are some advises about preventing nausea and vomiting in-duced by chemotherapy, patients with high and moderate emetic risk should avoid using 5-HT3RA exces-sively by increasing the dose and course of dexamethasone during the chemotherapy, and patients with low emetic risk should use 5-HT3RA or dexamethasone alone. It can make a significant contribution to the ra-tional use of drugs in clinic through back-feeding the problems of drug application to doctors.