化療引致噁心嘔吐之發生率及其相關因素

Incidence and Related Factors of Chemotherapy-Induced Nausea and Vomiting

陳美碧(Mei‐Bih Chen) ； 莊紫雲(Tzu‐Yun Chuang) ； 謝麗鳳(Lie‐Feng Hsieh)

《護理暨健康照護研究》 11卷3期 (2015/09) Pp. 206-215

https://doi.org/10.6225/JNHR.11.3.206

摘要

背景：化學藥物治療是癌症常見的治療方式之一，噁心、嘔吐是病人非常害怕的副作用，易導致預期性噁心、嘔吐的發生及生活品質的影響，研究發現噁心嘔吐有被低估的情形。目的：本研究主要瞭解癌症病人接受化療導致噁心嘔吐之發生情形、使用止吐劑治療狀況及其相關因素。方法：採前瞻性縱貫性研究設計，研究對象以方便取樣選取某醫學中心之癌症病人，共收案300人。於接受化療前一天以結構式問卷訪談收集資料，工具包括噁心嘔吐嚴重度評估表及情緒困擾量表，化療期間每日執行噁心、嘔吐評估且持續至治療後三天。結果：接受中、高致吐性化學藥物者有269人（89.7%），使用止吐劑者有289人（96.3%），而使用類固醇者77.3%、5-HT3 antagonist（5-Hydroxytryptamine3拮抗劑）70.7%、Emend 24.7%，合併使用三種止吐劑者13%。止吐劑使用符合NCCN（National Comprehensive Cancer Network）準則者僅占52.7%。本研究噁心發生率為54.3%，其中發生預期性噁心者8.7%、急性噁心34.3%、延遲性噁心45.7%；而嘔吐發生率為18.3%，其中發生預期性嘔吐者1.7%、急性嘔吐11.0%、延遲性嘔吐者13.3%。本研究結果發現，有預期性噁心及嘔吐經驗者、年齡較輕，易於化療期間引發噁心嘔吐情形，均達統計上顯著意義（p＜.05）；而化療引致嘔吐亦發現較易發生於癌症轉移者（χ^2=5.76, p＜.05），亦達顯著水準。結論：止吐劑之使用無法達到完全效果，建議臨床實務上，可合併非藥物處置以改善病人之噁心嘔吐及提升其生活品質。

關鍵字

化學治療 ； 噁心 ； 嘔吐

並列摘要

Background: Chemotherapy‐induced nausea and vomiting (CINV) is one of the most fearful treatment‐associated adverse effects in cancer patients. CINV not only significantly impairs patients' tolerability during treatment, but also results in anticipatory nausea and defective quality‐of‐life. It’s worthy to note that CINV is usually underestimated. Purpose: This study aimed to understand the incidence, the use of anti‐emetic therapeutics, and associated risk factors of CINV. Methods: This was a prospective longitudinal study that enrolled cancer patients received chemotherapy in a medical center in Taipei City. Data regarding the severity of CINV and associated emotional disturbance were collected based on a structured questionnaire. Every patient was visited and evaluated daily since the day before chemotherapy till three days post treatment. Results: There were 300 patients enrolled and analyzed in this study. Among all the patients, 269 patients (89.7%) received chemotherapy with high to moderate emetogenic potential. Almost all the patients in present cohort (n = 289, 96.3%) received anti‐emetic agents, including steroid (77.3%), 5‐HT3 (5‐ Hydroxytryptamine3) antagonist (70.7%), aprepitant (24.7%), and combination of above (13%), but only 52.7% of patient were prescribed with anti‐emetic agents as NCCN (National Comprehensive Cancer Network) guideline recommended. The incidence rate of nausea in our cohort was 54.3%, referring to 8.7% of patients had anticipatory nausea, 34.3% of patients had acute nausea, 45.7% of patients had delayed nausea. The incidence rate of vomiting was 18.3%, referring to 1.7% of patients had anticipatory vomiting, 11.0% of patients had acute vomiting, 13.3% of patients had delayed vomiting. Furthermore, we identified that young age, patients with metastatic cancer, the occurrence of anticipatory nausea, and prior experience of vomiting were significant risk factors for CINV, while there was a particular significant association between metastatic disease and chemotherapy‐induced vomit. Conclusions: In this study, we showed that the therapeutic effects of anti‐emetic agents to prevent CINV were not satisfactory by current practice. More efforts, such as combining non‐medication management, should be made to relieve the severity of CINV and improve the quality‐of‐life of patients.

並列關鍵字

chemotherapy ； nausea ； vomiting

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