盐酸昂丹司琼足三里穴位注射预防肿瘤化疗所致恶心呕吐的临床研究

摘要

To investigate difference between the effect on ondansetron point-injection on Zusanli and intrave-nous injection to prevent chemotherapy-induced nausea and vomitting,so as to seeking ways to improve therapeutic level of prevent chemotherapy-induced nausea and vomitting. Methods:This study was performed as a randomized control clinical trial. The patients were randomized to receive a single dose of ondansetron 4 mg,point-injection on Zusanli(treatment group),or ondansetron 8 mg by intravenous injection(control group),each administered 30 min before initiation of se-verely emetogenic chemotherapy. To observe the acute vomitting,delay vomitting,and acute nausea,and delay nausea,and administer rescue medication(intravenous injection with ondansetron)if the patient needed. Results:Sixty-two patients were randomized to the clinical trail,and 32 pts receiving ondansetron point-injection on Zusanli,30 pts receiving ondan-setron intravenous injection. The proportion of patients with no nausea during the 24h after chemotherapy administration (acute period)in treatment group and control group were significantly different(28. 13% vs 13. 33% , = 0. 012),and the proportion of patients with no nausea during delay(24h O 7days post-chemotherapy)and overall(0O7 days)peri-ods were higher in the treatment group than those of in the control group(75. 00% vs 65. 00% , = 0. 034). The propor-tion of patients with no vomitting during the 24 h after chemotherapy administration(acute period)in treatment group and control group werenˊt different(86.40% vs 80.00% ,=0.16),but the proportion of patients with no vomitting during delay(24h O7days post-chemotherapy)and overall(0O7 days)periods were higher in the treatment group than those of in the control group(53.33% vs 46.67% , = 0.037);Point-injection was superior to granisetron in control of nausea ( = 0. 019). The number of vomitting in the treatment group wasnˊt so many as that of the control group(average:1. 47 ±3.36 times/ case vs 3.12 ± 5. 80times/ case, = 0. 029). The cost to prevent chemotherapy-induced nausea and vomit-ting was significantly different(average:168. 98 ± 225. 30 yuans/ case vs 338. 27 ± 296. 40 yuans/ case, = 0. 031). The time to emetic episodes in the treatment group was longer than in the control group(=0.037). And ther were 12. 5%and 13.3% of patients in the treatment group and control group appeared lightly constipation,abdominal siatention and headache( = 1.000). Conclusion:Ondansetron point-injection on Zusanli is superior to intravenous injection for pre-venting chemotherapy-induced vomitting and nauesa,and it is safer and cheaper than intravenous injection.%目的：探讨昂丹司琼穴位注射与传统静脉注射治疗化疗所致恶心呕吐疗效的差异，寻求提高预防及治疗化疗所致呕吐的水平。方法：62例接受化疗的恶性肿瘤患者随机分为研究组和对照组。研究组32例昂丹司琼4 mg通过单侧足三里穴位注射，对照组昂丹司琼8mg通过静脉注射，均在化疗前30min给药，观察两组患者恶心、呕吐的发生情况，必要时给予解救性止吐治疗（重复静脉注射昂丹司琼）。结果：两组患者化疗期间及化疗后，研究组恶心的完全控制率（CRR）明显优于对照组（28.13% vs.13.33%，=0.023）；总有效率亦优于对照组（75.00% vs.60.00%，=0.034）。两组对化疗引起的急性呕吐（24h内）完全缓解率（CRR）比较无显著性差异（86.40% vs.80.00%，=0.16），但研究组对延迟性呕吐（24 h O 7天）完全控制率（ CCR）明显高于对照组（53.33% vs.46.67%，=0.037），研究组化疗后未出现呕吐（0 O 7天）的比例高于对照组（28.13% vs.13.33%，=0.012）。研究组化疗后人均呕吐发作次数少于对照组（=0.029）。研究组呕吐控制时间长于对照组（=0.039）。两组止吐平均费用研究组少于对照组（=0.031）。两组分别有12.5%和13.3%的受试者出现轻度便秘、腹胀及头痛等，无统计学差异。结论：昂丹司琼足三里穴位注射预防肿瘤化疗所致恶心呕吐优于静脉注射，且用量少，经济、安全。