CAJ | 학술논문

目的回顾性分析接受中高度致呕性化疗方案的恶性肿瘤患者出现爆发性呕吐后使用甲氧氯普胺联合奥氮平解救处理的疗效。方法本院2013年8月至2014年3月接受含铂类、蒽环类药物等中高度致呕性化疗方案的恶性肿瘤患者，化疗前常规止呕处理后出现爆发性呕吐的患者68例。其中46例接受高度致呕性化疗方案，常规止呕处理为化疗前30 min接受帕诺洛司琼0．25 mg静脉注射d1，联合地塞米松10 mg静脉注射d1～3；22例接受中度致呕性化疗方案，常规止呕处理为化疗前30 min接受昂丹司琼8 mg静脉注射d1～2，联合地塞米松10 m g静脉注射d1～3。化疗后确认出现爆发性呕吐后，予以甲氧氯普胺20 m g肌注、奥氮平10 m g口服，每天一次，使用3 d解救，监测解救用药后0～72 h的恶心、呕吐缓解状况以及其它不良反应发生情况。结果68例分别接受高度和中度致呕性化疗方案患者，解救治疗后其呕吐、恶心完全缓解率分别为80．9％（55／68）、75．0％（51／68）；不良反应主要为嗜睡13．2％（9／68）、疲劳10．3％（7／68）、头晕7．4％（5／68）等，未见明显的3～4级毒性反应。结论甲氧氯普胺联合奥氮平解救中高度致呕性化疗方案导致的爆发性呕吐有较好的疗效，无明显毒副作用，值得临床进一步推广。
목적회고성분석접수중고도치구성화료방안적악성종류환자출현폭발성구토후사용갑양록보알연합오담평해구처리적료효。방법본원2013년8월지2014년3월접수함박류、은배류약물등중고도치구성화료방안적악성종류환자，화료전상규지구처리후출현폭발성구토적환자68례。기중46례접수고도치구성화료방안，상규지구처리위화료전30 min접수파낙락사경0．25 mg정맥주사d1，연합지새미송10 mg정맥주사d1～3；22례접수중도치구성화료방안，상규지구처리위화료전30 min접수앙단사경8 mg정맥주사d1～2，연합지새미송10 m g정맥주사d1～3。화료후학인출현폭발성구토후，여이갑양록보알20 m g기주、오담평10 m g구복，매천일차，사용3 d해구，감측해구용약후0～72 h적악심、구토완해상황이급기타불량반응발생정황。결과68례분별접수고도화중도치구성화료방안환자，해구치료후기구토、악심완전완해솔분별위80．9％（55／68）、75．0％（51／68）；불량반응주요위기수13．2％（9／68）、피로10．3％（7／68）、두훈7．4％（5／68）등，미견명현적3～4급독성반응。결론갑양록보알연합오담평해구중고도치구성화료방안도치적폭발성구토유교호적료효，무명현독부작용，치득림상진일보추엄。
[Objective] To retrospectively analyze the efficacy of olanzapine combined with metoclopramide to treat explosive chemotherapy‐induced nausea and vomiting in patients with malignant tumor cancer receiving moderately and highly emetogenic chemotherapy .[Methods] Patients with malignant cancer receiving moder‐ately and highly emetogenic chemotherapy(platinum and anthracyclines) were chosen .Among 68 patients with explosive nausea and vomiting after conventional anti‐vomiting treatment before chemotherapy ,46 patients with highly emetogenic chemotherapy were treated with conventional anti‐vomiting therapy i .e .palonosetron 0 .25mg intravenously at d1 and dexamethasone 10mg intravenously once daily at d1~3 30min after chemothera‐py ,and 22 patients with moderately emetogenic chemotherapy were treated with conventional anti‐vomiting therapy i .e .ondansetron 8mg intravenously at d1~2 and dexamethasone10mg intravenously at d1~3 .When ex‐plosive nausea and vomiting appeared , all patients were given metoclopramide 20mg intramuscularly and olanzapine 10mg orally once daily for 3 days .The remission of nausea and vomiting and other adverse events at 0~24h after mediation were observed .[Results] A total of 68 patients with explosive nausea and vomiting af‐ter chemotherapy were treated .The efficacy was assessed .The complete remission(CR) rate of explosive vomiting and nausea were 80 .9% (55/68) and 75 .0% (51/68) ,respectively .The main side effects were drowsiness(13 .2% ,9/68) ,fatigue(10 .3% ,7/68) and dizziness(7 .4% ,5/68) and so on .No obvious grade 3~4 toxic reaction was found .[Conclusion]Metoclopramide combined with olanzapine for treating explosive nausea and vomiting induced by moderately and highly emetogenic chemotherapy had good efficacy without ob‐vious toxic and side reaction .Therefore ,it is worthy of clinical promotion .