课件：胡夕春 化疗相关性呕吐治疗进展.ppt

化疗药物致吐风险 中度致吐风险：呕吐发生率30%~ 90% 化疗药物致吐风险 低度致吐风险：呕吐发生率＜30% 化疗药物致吐风险 轻微致吐风险：呕吐发生率＜10% 高度致吐风险化疗的药物预防 5-HT3 R 拮抗剂 NK1受体 拮抗剂 地 塞 米 松 劳 拉 西 泮 125mg po 115mg iv 8-24/3/100/ 5/0.25mg 12mg 0.5-2mg q4-6h 80mg po 80mg po 8mg 8mg 8mg 0.5-2mg q4-6h 0.5-2mg q4-6h 0.5-2mg q4-6h 第1天 第2天 第3天 第4天 中度致吐风险化疗的药物预防 5-HT3 R 拮抗剂 NK1受体 拮抗剂 地 塞 米 松 劳 拉 西 泮 125mg po 115mg iv 8-24/3/100/ 5/0.25mg 12mg 0.5-2mg q4-6h 80mg po 80mg po 8mg 8mg 0.5-2mg q4-6h 0.5-2mg q4-6h 第1天 第2天 第3天 地塞米松 12 mg /日或 丙氯拉嗪10 mg q4-6 h或 甲氧氯普胺20-40 mg PO q4-6h/1-2 mg/kg IV q3-4h±苯海拉明25-50 mg q4-6 h ±劳拉西泮0.5-2 mg q4-6 h 低度致吐风险化疗的药物预防 预期性呕吐的预防 总原则是给予不同类型止吐药 非口服给药 多种药物联合（作用不同途径） 按时给药 足量补液，及时纠正电解质失衡 化疗相关性呕吐的解救治疗 化疗相关性呕吐的解救治疗 丙氯拉嗪 甲氧氯普胺±苯海拉明 劳拉西泮 5-HT3R 氟哌啶醇 屈大麻酚/大麻隆 奥氮平 异丙嗪 THANK YOU SUCCESS * * 可编辑 * Slide 6 A prospective evaluation of 832 cancer patients undergoing their first cycle of moderately to highly emetogenic chemotherapy has quantified the degree to which CINV compromises health-related quality of life.1 All patients were treated for emesis with a 5-HT3 receptor antagonist, either ondansetron or granisetron, before and during the first day of chemotherapy.1 Most patients also received concomitant dexamethasone prior to chemotherapy. The majority of patients continued to take a 5-HT3 receptor antagonist or dexamethasone, or both, for four to six days after chemotherapy.1 Before and after the initial chemotherapy course, patients kept diaries of nausea and vomiting and recorded the effects of CINV in five functional domains and a global domain on the 30-item European Organization for Research and Cancer core Quality-of-Life Questionnaire.1 Responses were stratified into four groups by the presence or absence of nausea or vomiting.1 Data were available for 685 patients. Group 1 (n=166) reported neither nausea nor vomiting at any time during the study; group 2 (n=30) reported vomiting but not nausea; group 3 (n=157) reported nau