化疗相关性呕吐治疗进展（可编辑）.doc

化疗相关性呕吐治疗进展 Mean changes in functional domain scores of health-related quality of life after eight days of chemotherapy Group 1 no nausea or vomiting Group 2 vomiting, no nausea 10 Group 3 nausea, no vomiting 5.3 5.3 Quality of Life Group 4 nausea and vomiting 4.9 Improved 5 b 1.9 0.8 f 0.6 0 d ?0.5 ?0.6 c ?0.6 ?1.1 ?1.1 ?2.6 a ?3.8 Quality of Life ?5 Diminished ?5.7 g ?7.4 e ?8.4 ?8.8 ?8.7 ?10 ?10 ?15 ?14.2 Physical Emotional Cognitive Social Global ?20 F Fu un nc ct tiio on na all d do om ma aiin n Group 1: n166; Group 2: n30; Group 3: n157; Group 4: n332 a b c d Group 1 vs. Group 4, p0.007; Group 1 vs. Group 4, p0.0001; Group 3 vs. Group 4, p0.0002; Group 3 vs. Group 4, p0.003; e f g Group 1 vs. Group 4, p0.0001; Group 2 vs. Group 4, p0.0005; Group 3 vs. Group 4, p0.002 Adapted from Osoba D et al Support Care Cancer 1997;5:307?313. Mean change in score Mean change in scoreNeed for Improved Control of CINV Most distressing adverse effects of chemotherapy before and during 5-HT receptor antagonist era 3 1983 1996 1983 1996 1 Being sick vomiting Feeling sick nausea 2 Feeling sick nausea Loss of hair 3 Loss of hair Being sick vomiting 4 Thought of coming for treatment Constantly tired 5 Duration of treatment at the clinic Need for an injection 6 Need to get a needle Constipation 7 Shortness of breatThought of coming for treatment 8 Constantly tired Affects family or partner 9 Difficulty sleeping Feeling low, miserable depression 10 Affects family or partner Feeling anxious or tense Adapted from de Boer-Dennert M et al Br J Cancer 1997;768:1055?1061; Coates A et al Eur J Cancer Clin Oncol 1983;19:203?208.肿瘤治疗相关呕吐 对病人生活质量和抗肿瘤治疗的影响 轻微 :不适感 严重 :脱水、电解质紊乱、营养不良、 胃肠道粘膜撕裂出血 治疗依从性降低 治疗贻误 中止有效治疗肿瘤治疗相关性呕吐 定义: 伴随肿瘤治疗过程中发生的恶心呕吐 CINV 化疗相关性恶心呕吐 Chemotherapy ? induced nausea and vomiting RINV 放疗相关性恶心呕吐 Radiation-Induced Nausea and VomitingCINV分类 急性呕吐 化疗后24h内发生 延迟性呕吐 化疗后24h or 更长时间 预期性呕吐 曾有CINV经历,化疗前、中、后发生 暴发性呕吐 预防处理后发生 难治性呕吐CINV预防、解救治疗失败CINV相关神经递质 5-羟色胺 组胺 Emetic P