奥氮平治疗恶性肿瘤非化疗所致恶心呕吐的临床疗效
|
摘要
目的:观察奥氮平治疗恶性肿瘤患者非化疗所致恶心、呕吐的疗效。方法:120例中晚期伴不同程度恶心呕吐的恶性肿瘤患者随机分为试验组(60例)和对照组(60例),两组分别予静脉注射地塞米松10 mg,1次/日,胃复安10 mg肌肉注射,1次/日,试验组在上述基础上口服奥氮平5 mg/d,睡前口服,用药3～7天不等,观察两组患者恶心呕吐缓解情况及KPS改善情况。结果:两组患者临床一般资料无统计学差异(P>0.05)。用药后两组患者恶心、呕吐症状分级(P=0.043)和止吐效果(P=0.046)有统计学差异,试验组有效控制率和完全控制率分别为96.7%和45.0%,明显优于对照组88.3%和21.7%,差异有统计学意义(P<0.05)。两组患者不良反应均轻微,差异无统计学意义(P>0.05)。结论:奥氮平治疗恶性肿瘤患者非化疗所致恶心、呕吐疗效明显,不良反应小,安全有效,且能改善患者体能状态,值得临床应用。
Objective:To observe the efficacy of olanzapine in the treatment of non-chemotherapy-induced nausea and vomiting.Methods:120 cases of malignant tumors with different degrees of nausea and vomiting were randomly divided into the experimental group(60 cases) and the control group(60 cases),The two groups were intravenously injected with dexamethasone 10 mg,1 times per day,intramuscular injection of metoclopramide 10 mg,1 times per day,the experimental group was given olanzapine 5 mg/d on the basis above,oral administration before bedtime,for 3～7 days.To observe the remission of nausea and vomiting,and the improvement of KPS.Results:There was no statistical difference in clinical general data between the two groups(P>0.05).After treatment,the symptoms of nausea and vomiting grade(P=0.043) and antiemetic effect(P=0.046) had statistically significant difference,the effective control rate and total control rate of the test group were 96. 7% and 45. 0%,respectively,which were significantly better than those of the control group( 88. 3% and 21. 7%),and the difference was statistically significant( P< 0. 05). The adverse reactions of the two groups were mild,and the difference was not statistically significant( P >0. 05). Conclusion: Olanzapine is effective in the treatment of non-chemotherapy-induced nausea and vomiting in malignant tumor patients. It has obvious side effects,safe and effective,and can improve physical condition of patients. It is worthy of clinical application.
Objective:To observe the efficacy of olanzapine in the treatment of non-chemotherapy-induced nausea and vomiting.Methods:120 cases of malignant tumors with different degrees of nausea and vomiting were randomly divided into the experimental group(60 cases) and the control group(60 cases),The two groups were intravenously injected with dexamethasone 10 mg,1 times per day,intramuscular injection of metoclopramide 10 mg,1 times per day,the experimental group was given olanzapine 5 mg/d on the basis above,oral administration before bedtime,for 3～7 days.To observe the remission of nausea and vomiting,and the improvement of KPS.Results:There was no statistical difference in clinical general data between the two groups(P>0.05).After treatment,the symptoms of nausea and vomiting grade(P=0.043) and antiemetic effect(P=0.046) had statistically significant difference,the effective control rate and total control rate of the test group were 96. 7% and 45. 0%,respectively,which were significantly better than those of the control group( 88. 3% and 21. 7%),and the difference was statistically significant( P< 0. 05). The adverse reactions of the two groups were mild,and the difference was not statistically significant( P >0. 05). Conclusion: Olanzapine is effective in the treatment of non-chemotherapy-induced nausea and vomiting in malignant tumor patients. It has obvious side effects,safe and effective,and can improve physical condition of patients. It is worthy of clinical application.
引文
[1] Yu Shiying,Yin Jiliang,Qing Shukui,et al.Guidelines for prevention and treatment of vomiting related to cancer treatment (2014 Edition) [J].Journal of Clinical Oncology,2014,19(3):263-273.[于世英,印季良,秦叔逵,等.肿瘤治疗相关呕吐防治指南(2014版)[J].临床肿瘤学杂志,2014,19(3):263-273.]
[2] Navari RM,Aapro.Antiemetic journal of clinical oncology,volume nineteenth,volume third,March 2014,guidelines for prevention and treatment of cancer related vomiting (2014 edition) rophylaxis for chemotherapy-induced nausea and vomiting[J].N Engl J Med,2016,374(14):1356-1367.
[3] Feng Zuoming,Dai Xiaoyan,Ding Xiaoxia.Therapeutic countermeasures for nausea and vomiting caused by chemotherapy with antitumor antibiotics [J].Chinese Journal of Antibiotics,2011,36(7):562-565.[冯作明,戴晓雁,丁晓霞.抗肿瘤抗生素药物化疗引起恶心、呕吐的治疗对策[J].中国抗生素杂志,2011,36(7):562-565.]
[4] Li Xiaomei,Dong Yanjuan,Li Huili,et al.Diagnosis and treatment strategies for nausea and vomiting in advanced cancer patients[J].Chinese Journal of Pain Medicine 2012,18(10):578-561.[李小梅,董艳娟,李慧莉,等.晚期肿瘤患者恶心呕吐的诊治策略[J].中国疼痛医学杂志,2012,18(10):578-561.]
[5] Shankar A,Roy S,Malik A,et al.Prevention of chemotherapy-induced nausea and vomiting in cancer patients[J].Asian Pac J Cancer Prev,2015,16(15):6207-6213.
[6] Meng Qi,Chen Guohua,Guo Peimin.Olanzapine combined with normal antiemetic drugs in patients on solid tumor chemotherapy:Antiemetic effect and impact on quality of life [J].World Chinese Journal of Digestology,2016,24(7):1117-1123.[孟琦,陈国华,郭培民.奥氮平联合常规止吐治疗防治实体瘤化疗相关性呕吐的疗效及对生活质量的影响[J].世界华人消化杂志,2016,24(7):1117-1123.]
[7] Zhao Jin,Li Xingde,Gao Jinghua,et al.Olanzapine prevention of nausea and vomiting caused by high and high emetogenic chemotherapy drugs [J].Modern Oncology,2014,22(8):1941-1943.[赵瑾,李兴德,高敬华,等.奥氮平预防中、高致吐化疗药物所致恶心、呕吐的临床观察[J].现代肿瘤医学,2014,22(8):1941-1943.]
[8] Chen Jungang,Xie Weili,Zhao Jianxiang.Clinical observation of olanzapine combined with tropisetron and dexamethasone in the prevention of nausea and vomiting induced by chemotherapy [J].Clinical Education of General Practice,2014,12(4):433-434.[陈军刚,谢炜丽,赵坚祥.奥氮平联合托烷司琼及地塞米松在预防恶性肿瘤化疗所致恶心呕吐临床疗效观察[J].全科医学临床与教育,2014,12(4):433-434.]
[9] Dalal S,Del Fabbro E,Bruera E.Symptom control in palliative care-Part I:Oncology as a paradigmatic example[J].J Palliat Med,2006,9:391-408.
[10] Chang VT,Hwang SS,Kasimis B,et al.Shorter symptom assessment instruments:The Condensed Memorial Symptom Assessment Scale (CMSAS)[J].Cancer Invest,2004,22:526-536.
[11] Callaghan JT,Bergstrom RF,Ptak LR,et al.Olanzapine:Pharmacokinetic and pharmacodynamic profile[J].Clin Pharmacokinet,1999,37:177-193.
[12] Salsman JM,Grunberg SM,Beaumont JL,et al.Communicating about chemotherapy-induced nausea and vomiting:A comparison of patient and provider perspectives[J].J Natl Compr Canc Netw,2012,10(2):149-157.
[13] Navari RM,Gray SE,Kerr AC.Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting:A randomized phaseⅢ trial[J].J Support Oncol,2011,9:188-195.
[14] Zhao Jin,Li Xingde,Gao Jinghua,et al.Curative effect and side effects of Olanzapine in treatment on nausea and vomiting caused by chemotherapy[J].Modern Oncology,2015,23(1):275-277.[赵瑾,李兴德,高敬华,等.奥氮平治疗化疗所致恶心、呕吐疗效及副反应的关系研究[J].现代肿瘤医学,2015,23(1):275-277.]
[15] National comprehensive cancer network.National comprehensive cancer network antiemesis guideline 2012[J].Professionals Physiciangls,2012,2:10.
[16] Zhou Dongai,Ma Jinan,Zhao Yanzhong,et al.Clinical observation of olanzapine in prevention of chemotherapy-induced nausea and vomiting in patients receiving highly emetogetic chemotherapy[J].Chinese Clinical Oncology,2017,22(5):436-440.[周冬爱,马进安,赵颜忠,等.奥氮平预防高致吐性化疗方案致恶心呕吐的临床观察[J].临床肿瘤学杂志,2017,22(5):436-440.]
[17] Li Jinhong,Wei Feng,Zhang Meng,et al.The clinical observation of small dose of olanzapine to prevent and control nausea and vomiting after chemotherapy[J].Modern Oncology,2015,23(9):2673-2675.[李金红,魏峰,张萌,等.小剂量奥氮平防治化疗后恶心呕吐的临床观察[J].现代肿瘤医学,2015,23(9):2673-2675.]
[18] He Shengxiu,Sun Yan,Chen Chunfeng,et al.Olanzapine in the prevention and treatment of malignant nausea and vomiting caused by chemotherapy[J].Heilongjiang Medicine Journal,2015,8(6):1266-1268.[何声秀,孙艳,陈春风,等.奥氮平在防治恶性肿瘤化疗所致恶心、呕吐中的临床应用[J].黑龙江医药,2015,8(6):1266-1268.]
[19] Flank J,Thackray J,Nielson D,et al.Olanzapine for treatment and prevention of acute chemotherapy-induced vomiting in children:A retrospective,multi-center review[J].Pediatr Blood Cancer,2015,62:496-501.
[20] Liu J,Tan L,Zhang H,et al.QoL evaluation of olanzapine for chemotherapy-induced nausea and vomiting comparing with 5-HT3 receptor antagonist[J].Eur J Cancer Care (Engl),2015,24:436-443.
[21] Yao Jine,Li Mingwei,Guan Jing,et al.Clinical research of olanzapine in improving quality of life in patients with cancer-related depression[J].Modern Oncology,2016,24(6):1949-1952.[姚金娥,李明伟,管静,等.奥氮平改善肿瘤相关性抑郁和焦虑患者生活质量的研究[J].现代肿瘤医学,2016,24(6):1949-1952.]
[2] Navari RM,Aapro.Antiemetic journal of clinical oncology,volume nineteenth,volume third,March 2014,guidelines for prevention and treatment of cancer related vomiting (2014 edition) rophylaxis for chemotherapy-induced nausea and vomiting[J].N Engl J Med,2016,374(14):1356-1367.
[3] Feng Zuoming,Dai Xiaoyan,Ding Xiaoxia.Therapeutic countermeasures for nausea and vomiting caused by chemotherapy with antitumor antibiotics [J].Chinese Journal of Antibiotics,2011,36(7):562-565.[冯作明,戴晓雁,丁晓霞.抗肿瘤抗生素药物化疗引起恶心、呕吐的治疗对策[J].中国抗生素杂志,2011,36(7):562-565.]
[4] Li Xiaomei,Dong Yanjuan,Li Huili,et al.Diagnosis and treatment strategies for nausea and vomiting in advanced cancer patients[J].Chinese Journal of Pain Medicine 2012,18(10):578-561.[李小梅,董艳娟,李慧莉,等.晚期肿瘤患者恶心呕吐的诊治策略[J].中国疼痛医学杂志,2012,18(10):578-561.]
[5] Shankar A,Roy S,Malik A,et al.Prevention of chemotherapy-induced nausea and vomiting in cancer patients[J].Asian Pac J Cancer Prev,2015,16(15):6207-6213.
[6] Meng Qi,Chen Guohua,Guo Peimin.Olanzapine combined with normal antiemetic drugs in patients on solid tumor chemotherapy:Antiemetic effect and impact on quality of life [J].World Chinese Journal of Digestology,2016,24(7):1117-1123.[孟琦,陈国华,郭培民.奥氮平联合常规止吐治疗防治实体瘤化疗相关性呕吐的疗效及对生活质量的影响[J].世界华人消化杂志,2016,24(7):1117-1123.]
[7] Zhao Jin,Li Xingde,Gao Jinghua,et al.Olanzapine prevention of nausea and vomiting caused by high and high emetogenic chemotherapy drugs [J].Modern Oncology,2014,22(8):1941-1943.[赵瑾,李兴德,高敬华,等.奥氮平预防中、高致吐化疗药物所致恶心、呕吐的临床观察[J].现代肿瘤医学,2014,22(8):1941-1943.]
[8] Chen Jungang,Xie Weili,Zhao Jianxiang.Clinical observation of olanzapine combined with tropisetron and dexamethasone in the prevention of nausea and vomiting induced by chemotherapy [J].Clinical Education of General Practice,2014,12(4):433-434.[陈军刚,谢炜丽,赵坚祥.奥氮平联合托烷司琼及地塞米松在预防恶性肿瘤化疗所致恶心呕吐临床疗效观察[J].全科医学临床与教育,2014,12(4):433-434.]
[9] Dalal S,Del Fabbro E,Bruera E.Symptom control in palliative care-Part I:Oncology as a paradigmatic example[J].J Palliat Med,2006,9:391-408.
[10] Chang VT,Hwang SS,Kasimis B,et al.Shorter symptom assessment instruments:The Condensed Memorial Symptom Assessment Scale (CMSAS)[J].Cancer Invest,2004,22:526-536.
[11] Callaghan JT,Bergstrom RF,Ptak LR,et al.Olanzapine:Pharmacokinetic and pharmacodynamic profile[J].Clin Pharmacokinet,1999,37:177-193.
[12] Salsman JM,Grunberg SM,Beaumont JL,et al.Communicating about chemotherapy-induced nausea and vomiting:A comparison of patient and provider perspectives[J].J Natl Compr Canc Netw,2012,10(2):149-157.
[13] Navari RM,Gray SE,Kerr AC.Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting:A randomized phaseⅢ trial[J].J Support Oncol,2011,9:188-195.
[14] Zhao Jin,Li Xingde,Gao Jinghua,et al.Curative effect and side effects of Olanzapine in treatment on nausea and vomiting caused by chemotherapy[J].Modern Oncology,2015,23(1):275-277.[赵瑾,李兴德,高敬华,等.奥氮平治疗化疗所致恶心、呕吐疗效及副反应的关系研究[J].现代肿瘤医学,2015,23(1):275-277.]
[15] National comprehensive cancer network.National comprehensive cancer network antiemesis guideline 2012[J].Professionals Physiciangls,2012,2:10.
[16] Zhou Dongai,Ma Jinan,Zhao Yanzhong,et al.Clinical observation of olanzapine in prevention of chemotherapy-induced nausea and vomiting in patients receiving highly emetogetic chemotherapy[J].Chinese Clinical Oncology,2017,22(5):436-440.[周冬爱,马进安,赵颜忠,等.奥氮平预防高致吐性化疗方案致恶心呕吐的临床观察[J].临床肿瘤学杂志,2017,22(5):436-440.]
[17] Li Jinhong,Wei Feng,Zhang Meng,et al.The clinical observation of small dose of olanzapine to prevent and control nausea and vomiting after chemotherapy[J].Modern Oncology,2015,23(9):2673-2675.[李金红,魏峰,张萌,等.小剂量奥氮平防治化疗后恶心呕吐的临床观察[J].现代肿瘤医学,2015,23(9):2673-2675.]
[18] He Shengxiu,Sun Yan,Chen Chunfeng,et al.Olanzapine in the prevention and treatment of malignant nausea and vomiting caused by chemotherapy[J].Heilongjiang Medicine Journal,2015,8(6):1266-1268.[何声秀,孙艳,陈春风,等.奥氮平在防治恶性肿瘤化疗所致恶心、呕吐中的临床应用[J].黑龙江医药,2015,8(6):1266-1268.]
[19] Flank J,Thackray J,Nielson D,et al.Olanzapine for treatment and prevention of acute chemotherapy-induced vomiting in children:A retrospective,multi-center review[J].Pediatr Blood Cancer,2015,62:496-501.
[20] Liu J,Tan L,Zhang H,et al.QoL evaluation of olanzapine for chemotherapy-induced nausea and vomiting comparing with 5-HT3 receptor antagonist[J].Eur J Cancer Care (Engl),2015,24:436-443.
[21] Yao Jine,Li Mingwei,Guan Jing,et al.Clinical research of olanzapine in improving quality of life in patients with cancer-related depression[J].Modern Oncology,2016,24(6):1949-1952.[姚金娥,李明伟,管静,等.奥氮平改善肿瘤相关性抑郁和焦虑患者生活质量的研究[J].现代肿瘤医学,2016,24(6):1949-1952.]