Clinical Study On Treatment Of Chemotherapy - Related Nausea And Vomiting By Abdominal

This dissertation consists of two parts:the literature review and the clinical research. The first part includes two literature reviews, which summarize the concept, the etiology and pathology of chemotherapy-induced nausea and vomiting (CINV) as well as the progression in the prevention and treatment of CINV in traditional Chinese medicine and western medicine respectively. The second part is a clinical research of studying the efficacy of abdominal acupuncture in the prevention and treatment of CINV.Background:CINV is one of the most common adverse effects associated with cancer treatment. The efficacy of antiemetic agents need to be improved when dealing with the delayed CINV. Meanwhile, the side effects of antiemetic agents also effect the quality of daily life seriously in some patients. However, according to some research, the abdominal acupuncture, a new form of acupuncture, can effeffectively reduce nausea and vomiting in the cisplatin chemotherapy with less side effects and higher compliance.Objectives:To compare the effective rate between abdominal acupuncture combined with antiemetic agents and antiemetic agentsin only in preventing CINV and to observe the effect of abdominal acupuncture in the quality of life, myrlosuppression, liver and kidney function.Methods:Selected 40 patients who would accept at least 2 cycles of chemotherapy in the Department of Integrated Oncology in China-Japan Friendship Hospital. Both highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) are sleeted. Before-After Trail in the Same Patient was used. Patients were divided into 2 groups by opaque sealed envelop. The two groups were called group AB and group BA. Group AB accepted abdominal acupuncture combined with tropisetron and metoclopramide during the first cycle and accepted tropisetron and metoclopramide only during the next cycle after 14 to 28 days. Group BA accepted tropisetron and metoclopramide during the first cycle and accepted abdominal acupuncture combined with tropisetron and metoclopramide during the next cycle after 14 to 28 days. Intervention:Group with abdominal acupuncture (Group A, n=40):Accepted abdominal acupuncture one time per day combined with tropisetron 5mg 30 minutes before chemotherapy and metoclopramide 10mg 30 minutes after chemotherapy from the first day to the last day of the chemotherapy. The needles were inserted to an approximate depth of 0.5 cun 30 minutes before chemotherapy and were retained for 30 minutes. The points selected were Zhongwan (CV12), Xiawan (CV10), Qihai (CV6) and Guanyuan (CV4). Control Group (Group B,n=40):Accepted tropisetron 5mg 30 minutes before chemotherapy and metoclopramide lOmg 30 minutes after chemotherapy from the first day to the last day of the chemotherapy. Make a record of the degree of CINV, the life quality score, other side effects brought by chemotherapy, blood routine examination, liver and kidney function before and after the chemotherapy.Results:The effective rate of acute nausea in group A and group B had no significant difference with each other (95% vs.92.5%, P>0.05). The effective rate of delayed nausea in group A was significantly higher than that of group B (75%-95% vs.35%～72.5%, P<0.05), especially in the 4th to 6th day of the chemotherapy (P<0.01). The effective rate of group A was significantly higher than that of group B in the 3th to 6th day of the highly emetogenic chemotherapy. The effective rate has no significant difference in the moderate emetogenic chemotherapy (P>0.05).The effective rate of acute vomiting in group A and group B had no significant difference with each other (95% vs.92.5%, P>0.05). The effective rate of delayed vomiting in group A was significantly higher than that of group B in the 3th to 5th day of the chemotherapy (80%～95%vs.52.5%～75%, P<0.05), especially in the 4th day (P<0.01). The effective rate of group A was significantly higher than that of group B in the 4th and 5th day of the highly emetogenic chemotherapy. The effective rate has no significant difference in the moderate emetogenic chemotherapy.The incidence of constipation and abdominal distension in group A was lower than that of group B (P<0.05). The life quality score in group A was significantly higher than that of group B(P<0.05). Blood routine examination, liver and kidney function has no significant difference between the two groups.Conclusions:1.Abdominal acupuncture combined with tropisetron and metoclopramide can prevent CINV effectively, especially delayed CINV in the highly emetogenic chemotherapy.2.Abdominal acupuncture can relief other side effects like constipation and abdominal distension occurred during the chenmotherapy and improve the life quality score to some degree.3.We haven’t found abdominal acupuncture can prevent chemotherapy-induced myelosuppression, liver dysfunction or kidney dysfunction.