胡夕春--化疗相关性呕吐治疗进展.ppt

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1、化疗相关性呕吐治疗进展上海肿瘤医院胡夕春提高缓解率恶性肿瘤治疗目标延长生存期延长DFS根治提高生活质量细胞毒药物在肿瘤治疗中占据越来越重要的地位CINVCompromisesQualityofDailyLifeGroup1:n=166;Group2:n=30;Group3:n=157;Group4:n=332aGroup1vs.Group4,p=0.007;bGroup1vs.Group4,p=0.0001;cGroup3vs.Group4,p=0.0002;dGroup3vs.Group4,p=0.003;eGroup1vs.Group4,p=0.0001;f

2、Group2vs.Group4,p=0.0005;gGroup3vs.Group4,p=0.002AdaptedfromOsobaDetalSupportCareCancer1997;5:307–313.Meanchangesinfunctionaldomainscoresofhealth-relatedqualityoflifeaftereightdaysofchemotherapyMeanchangeinscoreQualityofLifeDiminishedQualityofLifeImprovedGroup1(nonauseaorvomiting)G

3、roup2(vomiting,nonausea)Group3(nausea,novomiting)Group4(nauseaandvomiting)–20–15–10–505101.9b–0.6–1.1c–8.4–2.6–0.6–0.5d–8.8e0.6f–1.1–7.4g–14.2–3.8a–5.7–8.7–105.35.34.90.8PhysicalEmotionalCognitiveSocialGlobalFunctionaldomainNeedforImprovedControlofCINV198319961Beingsick(vomiting)Feel

4、ingsick(nausea)2Feelingsick(nausea)Lossofhair3LossofhairBeingsick(vomiting)4ThoughtofcomingfortreatmentConstantlytired5DurationoftreatmentattheclinicNeedforaninjection6NeedtogetaneedleConstipation7ShortnessofbreatThoughtofcomingfortreatment8ConstantlytiredAffectsfamilyorpartner9Diffi

5、cultysleepingFeelinglow,miserable(depression)10AffectsfamilyorpartnerFeelinganxiousortenseMostdistressingadverseeffectsofchemotherapybeforeandduring5-HT3receptorantagonisteraAdaptedfromdeBoer-DennertMetalBrJCancer1997;76(8):1055–1061;CoatesAetalEurJCancerClinOncol1983;19:203–208.肿瘤治疗

6、相关呕吐对病人生活质量和抗肿瘤治疗的影响轻微：不适感严重：脱水、电解质紊乱、营养不良、胃肠道粘膜撕裂出血治疗依从性降低治疗贻误中止有效治疗肿瘤治疗相关性呕吐定义:伴随肿瘤治疗过程中发生的恶心呕吐CINV化疗相关性恶心呕吐Chemotherapy–inducednauseaandvomitingRINV放疗相关性恶心呕吐Radiation-InducedNauseaandVomitingCINV分类急性呕吐化疗后24h内发生延迟性呕吐化疗后>24hor更长时间预期性呕吐曾有CINV经历，化疗前、中、后发生暴发性呕吐预防处理后发生难治性呕吐CINV预防、解救治疗失

7、败CINV相关神经递质*Gamma-aminobutyricacid.DiemunschP,GrélotLDrugs2000;60:533–546.GrunbergSM,HeskethPJNEnglJMed1993;329:1790–1796.HornbyPJAmJPhysiolGastrointestLiverPhysiol2001;280:G1055–G1060.5-羟色胺乙酰胆碱组胺内啡肽类多巴胺P物质GABA*EmeticReflex呕吐发生的解剖学机制外周通路：迷走神经传入纤维、交感神经节、舌咽神经等催吐化学感受区(Chemoreceptortrig

8、gerzone，CTZ)