上海市癌症患者化疗所致恶心呕吐的横断面研究  

Chemotherapy-induced nausea and vomiting among cancer patients in Shanghai:a cross-sectional study

作　　者：曾铖 金奕滋 李婷 章真[3] 梁晓华 唐曦 刘天舒 李琦 沈赞[8] 姜斌[9] 王理伟[10] 张俊[11] 陈思宇[12] 周彩存[13] 高勇[14] 臧远胜 李恒宇 董宇超 湛先保 钟薏 刘苓霜[20] 秦悦农[21] 胡夕春[1] 张剑[1,2] ZENG Cheng;JIN Yizi;LI Ting;ZHANG Zhen;LIANG Xiaohua;TANG Xi;LIU Tianshu;LI Qi;SHEN Zan;JIANG Bin;WANG Liwei;ZHANG Jun;CHEN Siyu;ZHOU Caicun;GAO Yong;ZANG Yuansheng;LI Hengyu;DONG Yuchao;ZHAN Xianbao;ZHONG Yi;LIU Lingshuang;QIN Yuenong;HU Xichun;ZHANG Jian(Department of Medical Oncology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;PhaseⅠClinical Trial Center,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Key Laboratory of Radiation Oncology,Shanghai Clinical Research Center for Radiation Oncology,Shanghai 200032,China;Department of Oncology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Oncology,Huadong Hospital,Fudan University,Shanghai 200040,China;Department of Medical Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Oncology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Department of Oncology,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Oncology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201999,China;Department of Oncology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Oncology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Oncology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Medical Oncology,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China;Department of Oncology,Shanghai East Hospital,School of Medicine of Tongji University,Shanghai 200120,China;Department of Medical Oncology,The Second Affiliated Hos

机构地区：[1]复旦大学附属肿瘤医院肿瘤大内科,复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学附属肿瘤医院Ⅰ期临床试验病房,复旦大学上海医学院肿瘤学系,上海200032 [3]复旦大学附属肿瘤医院放射治疗中心,复旦大学上海医学院肿瘤学系,上海市放射肿瘤学重点实验室,上海市放射治疗临床医学研究中心,上海200032 [4]复旦大学附属华山医院肿瘤科,上海200040 [5]复旦大学附属华东医院肿瘤科,上海200040 [6]复旦大学附属中山医院肿瘤内科,上海200032 [7]上海交通大学医学院附属第一人民医院肿瘤科,上海200080 [8]上海交通大学医学院附属第六人民医院肿瘤内科,上海200233 [9]上海交通大学医学院附属第九人民医院肿瘤科,上海201999 [10]上海交通大学医学院附属仁济医院肿瘤科,上海200127 [11]上海交通大学医学院附属瑞金医院肿瘤科,上海200025 [12]上海交通大学医学院附属新华医院肿瘤科,上海200092 [13]同济大学附属上海市肺科医院肿瘤科,上海200433 [14]同济大学附属东方医院肿瘤科,上海200120 [15]海军军医大学第二附属医院肿瘤科,上海200070 [16]海军军医大学第一附属医院甲乳外科,上海200433 [17]海军军医大学第一附属医院呼吸与危重症医学科,上海200433 [18]海军军医大学第一附属医院肿瘤科,上海200433 [19]上海中医药大学附属上海市中西医结合医院肿瘤科,上海200082 [20]上海中医药大学附属龙华医院肿瘤科,上海200032 [21]上海中医药大学附属龙华医院中西医结合乳腺科,上海200032

出　　处：《中国癌症杂志》2023年第11期1009-1017,共9页China Oncology

摘　　要：背景与目的:化疗所致恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)可使癌症患者机体功能紊乱,甚至导致死亡。预防CINV对于接受致吐性化疗方案的患者至关重要。本研究旨在分析上海市三甲医院CINV的发生情况及处理方式,探讨与CINV相关的危险因素,以期进一步改善CINV管理。方法:选取2022年10月—2022年12月在上海市16家三甲医院接受治疗的376例癌症患者作为研究对象,采用问卷调查的方式开展横断面研究。使用单因素和多因素logistic回归模型分析CINV的影响因素。结果:2022年上海市CINV管理与指南符合率较5年前有显著改善。对于接受高致吐风险化疗方案的患者,指南符合率从21.6%提升至67.0%。对于接受中致吐风险化疗方案的患者,神经激肽-1(neurokinin-1,NK-1)受体抑制剂的使用并不能显著降低CINV的发生率。多因素分析显示,化疗方案是CINV发生的唯一独立危险因素(P<0.05)。结论:化疗方案是影响CINV发生的独立危险因素,临床实践中应优先关注药物本身的致吐风险,做好风险评估,严格遵循指南,从而最大化地控制CINV。Background and purpose:Chemotherapy-induced nausea and vomiting(CINV)can cause severe damage to body functions and even lead to death.The prevention of CINV is critically important in patients receiving emetogenic chemotherapy regimen.This study aimed to investigate the prevalence and treatment of CINV in Grade-A tertiary hospitals in Shanghai and explore risk factors of CINV to improve its management.Methods:The clinical data of 376 cancer patients in Grade-A tertiary hospitals in Shanghai from October 2022 to December 2022 were collected retrospectively.The questionnaire was used to conduct a cross-sectional study.The univariate and multivariable logistic regression models were used to evaluate the influencing factors of CINV.Results:The management and coincidence of the guideline in 2022 significantly improved compared to five years ago.For patients receiving high-emetic-risk chemotherapy regimen,the coincidence of the guideline increased from 21.6%to 67.0%.For patients receiving moderate-emetic-risk chemotherapy regimen,the neurokinin-1(NK-1)receptor antagonist was not significantly associated with CINV.Multivariable analysis showed that the chemotherapy regimen was the only risk factor for CINV during the whole period(P<0.05).Conclusion:The chemotherapy regimen is the main risk factor for CINV.To control CINV better,clinical practitioners should focus on the intrinsic risk of chemotherapy regimens preferentially,estimate the risk and adhere better to guidelines.

关 键 词：化疗所致恶心呕吐 癌症 横断面研究 

分 类 号：R730.6[医药卫生—肿瘤]