穴位注射VB6联合中药穴位敷贴对急性髓系白血病化疗后恶心呕吐的应用研究

【作者】 刘杰；

【导师】 刘恒；

【作者基本信息】 青岛大学 ， 护理学， 2023， 硕士

【摘要】 目的探讨穴位注射维生素B₆（VB₆）联合中药穴位敷贴对急性髓系白血病患者化疗相关性恶心呕吐的应用效果,为在临床实践中降低恶心、呕吐发生率及严重程度、改善患者的生存质量提供科学依据。方法选取山东省某三甲医院132名急性髓系白血病化疗患者,通过电脑随机法,将样本数（132例）、分组数（4组）输入SPSS22.0软件中,生成随机种子数和分组数,另A表示对照组,B表示穴位注射组,C表示穴位贴敷组,D表示穴位注射联合穴位敷贴组,每组33例。所有患者均采用IA化疗方案（伊达比星+阿糖胞苷）,均于化疗前30分钟予以基础用药（地塞米松+帕洛诺司琼）。A组仅给予基础药物治疗;B组在足三里穴位注射VB₆;C组在特定穴位上贴敷调制好的中药贴;D组联合治疗（B组+C组）。干预治疗后观察患者的恶心发生率及严重程度、呕吐发生率及严重程度,并评价其生存质量。数据处理采用SPSS 26.0统计分析软件。结果（1）恶心发生率比较（1）急性恶心发生率比较:化疗开始的24 h内四组患者恶心发生率不同,差异有统计学意义（P<0.001）。组间两两比较,结果显示,化疗24 h内B组和D组的恶心发生率均显著低于A组和C组（P<0.05）,其余各组间无差异（P>0.05）,D组的恶心发生率最低。（2）延迟性恶心发生率比较:化疗结束后1-4 d四组患者的恶心发生率不同,差异有统计学意义（P<0.001）。组间两两比较,C组和D组的恶心发生率均显著低于A组和B组（P<0.05）,其余各组间无差异（P>0.05）,D组的恶心发生率最低。（2）呕吐发生率比较（1）急性呕吐发生率比较:化疗开始的24 h内四组患者呕吐发生率不同,差异有统计学意义（P<0.001）。组间两两比较,结果显示,化疗24 h内B组和D组的呕吐发生率均显著低于A组和C组（P<0.05）,其余各组间无差异（P>0.05）,D组的呕吐发生率最低。（2）延迟性呕吐发生率比较:化疗结束后1-4 d四组患者的呕吐发生率不同,差异有统计学意义（P<0.001）。组间两两比较,C组和D组的呕吐发生率均显著低于A组和B组（P<0.05）,其余各组间无显著差异（P>0.05）,D组的呕吐发生率最低。（3）恶心、呕吐严重程度的比较（1）中重度恶心占比比较:在化疗期间第1-3 d、4-7 d和化疗结束后1-3 d,四组的中重度恶心占比具有统计学意义（P<0.05）,化疗结束后4-7 d四组间无统计学差异（P>0.05）。组间两两比较,D组中重度恶心占比与A组相比,在化疗期间第1-3d,4-7 d和化疗结束后1-3 d有统计学差异（P<0.05）,其余两两比较显示均无统计学差异（P>0.05）,其中D组的中重度恶心占比最低。（2）中重度呕吐占比比较:在化疗期间第1-3 d和第4-7 d,四组患者中重度呕吐占比差异有统计学意义（P<0.05）。化疗结束后的1-3 d和4-7 d,四组患者的中重度呕吐占比差异无统计学意义（P>0.05）。组间两两比较,D组患者的呕吐程度与A组患者在化疗期间的第1-3 d和4-7 d（P<0.05）有统计学差异,其余两两比较显示均无统计学差异（P>0.05）。（4）四组患者生存质量分析四组患者生存质量量表评分结果显示:四组患者在干预前生存质量评分,无统计学差异（P>0.05）,可以进行干预实验。干预后生存质量评分,有统计学意义（P<0.05）,具体评分对比差异A<B<C<D。结论1.穴位注射VB₆可降低急性髓系白血病患者的恶心、呕吐的发生率;中药穴位敷贴可降低延迟性恶心、呕吐的发生率;二者联合应用于急性髓系白血病患者,能明显降低恶心、呕吐的发生率,并可减轻恶心、呕吐的严重程度。2.穴位注射VB₆联合中药穴位敷贴,能明显改善患者的生存质量,保障化疗周期顺利完成。3.穴位注射VB₆联合中药穴位敷贴对化疗相关恶心、呕吐的疗效,要优于单独使用其中任何一种疗法。更多还原

【Abstract】 ObjectivePoint injection vitamin B₆ combined with traditional Chinese medicine acupoint sticking of chemotherapy in patients was applied to explore the application effect of which on acute myeloid leukemia correlated nausea and vomiting,which will be able to reduce the incidence of nausea and vomiting in clinical practice and severity,and provide a scientific basis for improve the patients’quality of life.MethodsThe 132 patients with acute myeloid leukemia chemotherapy selected in A3 armour hospital in shandong province,the computer random grouping was adopted to classify the sample（132 cases）to the number of clusters（group 4）,producing sample of 33 cases in each group,ordinal numbers for group A（control group）,group B（acupoint injection group）,group C（meridian sticking group）and group D（joint of acupoint sticking point injection group）.All patients were adopt IA chemotherapy than star plus cytarabine（IDA）,both at 30 minutes before chemotherapy based drugs（Dexamethasone+Palonosetron）.Group A only was given drug treatment;Group Bwas injected with VB₆ at Zusanli acupoint.Group C was pasted a prepared Chinese medicine patch in specific acupoints;Group D combined treatment group（group B+C）.Intervention after the incidence and severity was observed in patients with nausea,vomiting incidence and severity,and evaluate the quality of life.Data processing was analysised by SPSS 26.0 statistical analysis software.Results（1）Incidence of nausea comparison（1）Incidence of acute nausea:the incidence of nausea in four groups of patients within 24 h of chemotherapy eas different with statistical significance（P<0.001）.Pairwise comparison between two groupswas adopted.The results showed that the incidence of nausea in group B and D group within 24 hours of chemotherapy were significantly lower than that of group A and group C（P<0.05）,and there was no difference in other groups（P>0.05）.Group D had the lowest incidence of nausea.（2）Incidence of delayed nausea comparison:the incidence of nausea in four groups was different after 1-4 days of the chemotherapy,and the difference was statistical significance（P<0.001）.Pairwise comparison between groups,the incidence of nausea in group C and D group were significantly lower than that of group A and group B（P<0.05）,and no difference was occurred in other groups（P>0.05）,and group D had the lowest incidence of nausea.（2）Incidence of vomiting comparison（1）Incidence of acute vomiting comparison:the incidence of vomitingin the four groups of patients within 24h of beginning chemotherapy was different,and the difference was statistically significant（P<0.001）.Pairwise comparison between two groups was adopted.The results showed that,within 24 h of chemotherapy,the incidence of vomiting in group B and D group were significantly lower than that of group A and group C（P<0.05）,and no difference was occurred in other groups（P>0.05）.The group D had the lowest incidence of vomiting.（2）Incidence of delayed vomiting:the incidence of vomiting in four groups after 1-4d of chemotherapy was significantly different（P<0.001）.Pairwise comparison between groups,the incidence of vomiting in group C and D groups were significantly lower than that of group A and group B（P<0.05）,and no difference was occurred in other groups（P>0.05）,and group D had the lowest incidence of vomiting.（3）compare the severity of nausea and vomiting（1）Moderat severe nausea of comparison:during 1-3 d and 4-7 d of chemotherapy and after 1-3 d of chemotherapy,moderate severe nausea in the four groups had statistical significance（P<0.05）.During 4-7 d of chemotherapy,there was no statistical differences between the four groups（P>0.05）.Pairwise comparison between two groups,moderate severe nausea proportion in group D,compared with group A,during 1-3 d and 4-7 d of chemotherapy and after 1-3 d of chemotherapy had statistical difference（P<0.05）.The remaining groups with pairwise comparison showed no statistical difference（P>0.05）,and the group D had the minimum of moderate severe nausea.（2）Excessie omiting accounted for comparison:During chemotherapy,1-3 d and 4-7d,four groups of patients with moderate severe vomiting accounted for differences with statistical significance（P<0.05）.After the chemotherapy of 1-3 d and 4-7 d,four groups of patients with moderatel severe vomiting accounted for differences with no statistical significance（P>0.05）.Between two groups,group D degree of vomiting patients with A group of patients during chemotherapy of 1-3 d and 4-7 d（P<0.05）was statistical difference,the two remaining two comparison showed no statistical difference（P>0.05）.（4）Four groups of patients’survival quality rating scaleFour groups of patients’survival quality rating scale results:four patients’quality of life scores before intervention,no statistical difference（P>0.05）,can intervene the experiment.Quality of life score after intervention,there is statistical significance（P<0.01）,a specific score comparison difference A<B<C<D.Results1.VB₆ point injection can reduce the incidence of nausea and vomiting in acute myeloid leukemia patients;Traditional Chinese medicine acupoint sticking can reduce the incidence of delayed nausea and vomiting;The joint applied in patients with acute myeloid leukemia,can significantly reduce the incidence of nausea,vomiting,and can reduce the severity of nausea and vomiting.2.Jointing Chinese medicine acupuncture point injection with VB₆ patches,can obviously improve the patient’s quality of life,safeguard chemotherapy cycle is completed.3.The VB₆ combined Chinese medicine acupoint sticking point injection on the curative effect of chemotherapy on nausea,vomiting,is superior to use any kind of therapy alone.更多还原