Clinical Research Of Olanzapine Combined With Tropisetron And Dexamethasone For The Prevention Of Nausea And Vomiting After Transcatheter Arterial Chemoembolization For Primary Hepatic Carcinoma

BackgroundPrimary liver cancer(PHC)is one of the most common gastrointestinal malignancies in the world and the early clinical symptoms of PHC are not typical.Most patients have lost the chance of surgery when the disease is found.Transcatheter transcatheter arterial chemoembolization(TACE),as one of the preferred treatment regimens for advanced and moderate PHC patients,can control tumor progression and prolong survival,but the postoperative nausea and vomiting is a major clinical problem.It seriously affected the quality of life of patients,and cause anxiety,depression,and reduce patient treatment compliance,severe nausea and vomiting to induce cirrhosis esophagus-stomach meridians varicose rupture hemorrhage,can be directly lead to death.Currently,5-HT3 receptor blockers(5-HT3RA)combined with dexamethasone reduce the incidence of nausea and vomiting,but there are still some patients with more stubborn nausea and vomitin symptoms,the effect of the current control means is not ideal.In recent years,the NCCN guidelines suggest that medications(such as olanzapine,clozapine,etc.),which are major therapeutic psychiatric disorders,can be used for the prevention and treatment of chemotherapy-related nausea and vomiting(CINV).Olanzapine,in combination with multiple receptors associated with nausea and vomiting,play its anti-vomiting effect.A variety of studies have shown that the combination of 5-HT3RA,corticosteroids onchemotherapy-relatedCINV effective.However,few studies have reported the effectiveness of olanzapine combined with the above program for the prevention of nausea and vomiting after transcatheter arterial chemoembolization for hepatocellular carcinoma.This article aims to explore the clinical curative effect of olanzapine for nausea and vomiting after TACE for hepatocellular carcinoma.ObjectiveTo investigate the effectiveness and side effects of olanzapine combined with tropisetron and dexamethasone in prevention of acute and delayed nausea and vomiting after transcatheter arterial chemoembolization for primary hepatic carcinoma.MethodsAfter the strict inclusion and exclusion criteria,we included 30 patients with primary hepatic carcinoma receiving transcatheter arterial chemoembolization in department of infectious diseases from Shandong Provincial Hospital from October,2016 to January,2017.This is a befor-after clinical study in the same patients.Thirty patients underwent two TACEsuccessively,The first TACE treatment use A program to prevent nausea and vomiting.A program as follows:4mg tropisetron and 5mg dexamethasone intravenously 30 minutes before TACE to prevent nausea and vomiting.The second time to accept TACE treatment using B program:tropisetron and dexamethasone which was the same dose of the control group,and oral olanzapine 5 mg was given before TACE.12 cases were used for 1 day,6 patients for 2 days,6 patients for 3 days,4 patients for 4 days,and 2 for 5 days.The primary end point are nausea and vomiting symptoms score of 0-24h?25-120h?0-120h after TACE;nausea prenention0-24h?25-120h?0-120h after TACE;A complete response(no emesis and no use of rescue medication)of 0-24h,25-120h,0-120 h after TACE.The second endpoint are adverse reaction and safety of olanzapine.ResultsThe primary end point1?The scores of nausea and vomiting were respectively:5.3±2.8 vs.7.3± 2.4,6.0±6.0 vs.13.9 ± 5.5,and 11.3±8.0 vs.21.1 ± 6.9 for program B and program A of 0-24h,25-120h,0-120h.P values were less than 0.05,the difference was statistically significant.2?The control rates of nausea were respectively 46.7%vs.26.7%,53.3%vs.26.7%,33.3%vs.6.7%for program B and program A of 0-24h,25-120h and 0-120.P values were less than 0.05,the difference was statistically significant.3?The complete response rates for program B and program A respectively were 53.3%vs.26.7%,86.7%vs.40%,53.3%vs.16.7%,and the P values were less than 0.05,the difference was statistically significant.Secondary study end point:Some patients with oral olanzapine for program B were drowsy on the next day.In addition,the program B and program A were no significant toxic reactions.ConclusionsOlanzapine combined with 5-HT3RA,dexamethasone is safe and effective for preventing nausea and vomiting among the patients of transcatheter arterial chemoembolization for hepatocellular carcinoma.