| Objective:By comparing the efficacy and safety of different doses(0mg,5mg,10mg)of dexamethasone(Dexamethasone,DXM)combined with 5-hydroxytryptamine-3 receptor antagonists(5-hydroxytryptamine-3 receptor antagonists,5-HT3RA)in the control of chemotherapy-induced nausea and vomiting(Chemotherapy-induced nausea and vomiting,CINV)induced by cisplatin,this paper discusses the best dose of dexamethasone in the treatment of CINV.Methods:This experiment is a Prospective cohort study.According to the inclusion and exclusion criteria,patients with head and neck malignancies hospitalized in the Department of Oncology,the Affiliated Hospital of Youjiang Ethnomedicine from August 2020 to October2022 were selected as the inclusion group.The cisplatin synchronous radiotherapy and chemotherapy regimen was used,all of which were intensity modulated radiotherapy with a radiation dose of 66-70Gy/30-33 F.The chemotherapy was performed with cisplatin 40mg/m2 once a week,with the first week of cisplatin chemotherapy being the observation period.According to the different doses of DXM in the antiemetic regimen,patients were randomly divided into A group,B group,and C group.Antiemetic regimen: Group A 0mg DXM+5-HT3 RA;Group B 5mg DXM+5-HT3 RA,Group C 10 mg DXM+5-HT3 RA.Complete relevant examination before starting treatment to eliminate the contraindications of radiotherapy and chemotherapy.Complete relevant examination before starting treatment to eliminate the contraindications of radiotherapy and chemotherapy.In the first week,cisplatin chemotherapy was used as the observation period.On the day of chemotherapy,antiemetic drugs were injected intravenously for 3 consecutive days.The degree of nausea and vomiting in each group was evaluated according to the World Health Organization(the World Health Organization,WHO)criteria for the toxicity reaction of anti-tumor drugs.The effective rate of nausea and vomiting in the acute phase(d1),delayed phase(d2-5),and whole phase(d1-5)of each group was observed and recorded respectively,and passed the x2 test or t test,Compare the basic clinical data before radiotherapy and chemotherapy among the three groups,and the difference in the complete remission rate of nausea and vomiting after treatment,and evaluate the efficacy,adverse reactions and quality of life before and after treatment of different doses of DMX antiemetic regimen.Results:(1)Comparison of basic data of patients in group A,B and C: A total of 92 patients were enrolled,including 30 patients in group A,30 patients in group B and 32 patients in group C.There were no significant differences in clinical data(such as gender,height,weight,TNM stage,tumor type,previous chemotherapy history,history of targeted drugs,motion sickness,etc.)among group A,group B and group C(P>0.05),indicating comparability.(2)Comparison of vomiting control among Group A,B and C patients during the observation period:In acute phase(d1)and general phase(D1-5),the rates of complete response(CR)in groups A,B and C were 29(96.66%),30(100.00%),32(100.00%)and 16(53.33%),18(60.00%),and 26(81.25%),respectively.There was no significant difference in acute stage and overall stage among all groups(P>0.05).In the delay period(d2-5),the rates of complete remission(CR)in group A,group B and group C were 22(73.33%),25(83.33%)and 29(96.88%),respectively,and the differences among groups were statistically significant(P<0.05).The test showed that there was statistical difference between groups A and B(P<0.05),B and C(P<0.05),and A and C(P<0.05).(3)Comparison of the curative effects of three groups of patients on nausea at different stages:In the acute observation period(d1),the complete remission rates CR of group A,B and C were 21(70.00%),25(83.33%)and30(93.75%),respectively,with no statistical difference(P<0.05).The test showed that there was statistical difference between groups A and B(P<0.05),B and C(P<0.05),and A and C(P<0.05).The CR rates in groups A,B and C were 20(66.67%),23(76.67%),25(78.13%)and 12(40.00%),16(53.33%),20(62.50%),respectively,in the delayed observation period(d2-5)and the global period(d1-5).There was no significant difference in the delay period and the overall period(P>0.05).(4)The QOL scores of patients in the three groups of quality of life A,B and C were 54.67 ± 1.3,54.30 ± 1.5 and 54.50 ± 1.3 respectively.There was no statistically significant difference in the scores of the three groups before chemotherapy(P>0.05).After treatment,the QOL scores of patients in the three groups were 54.16 ± 1.4,55.40 ± 1.1 and 53.81 ± 1.4 respectively.Group B was higher than Group A and C,and the QOL scores of the three groups were statistically different(P<0.05).(5)Three groups of patients had adverse reactions related to antiemetic drugs during treatment.Among them,fatigue,constipation and hiccup are common,and there is no statistical difference between the three groups(P>0.05).The proportion of pain in group A,B and C was 33.3%(10 cases),16.7%(5cases)and 6.25%(2 cases)respectively,the difference was statistically significant(P<0.05).Conclusion:(1)Through this study,it was found that both 5mg and 10 mg dexamethasone have good therapeutic effects on vomiting in the acute phase.However,in the delayed phase,the 10 mg group has better antiemetic efficacy compared to the 5mg group and the non dexamethasone group.(2)The control rate of CINV without dexamethasone during the acute and delayed stages was lower than that of patients in the 5mg and 10 mg groups.(3)5mg dexamethasone is more effective in improving the quality of life of patients and has good safety. |
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