中国针灸

目的：观察药物铺灸辅助治疗胃癌脾胃虚寒型化疗相关性恶心呕吐（CINV）的临床疗效。方法：将76例胃癌脾胃虚寒型CINV患者随机分为观察组（38例，中止1例、脱落1例）和对照组（38例，中止1例）。两组患者均采用顺铂+替吉奥方案化疗，在化疗第1～3天予基础止呕药物治疗。观察组辅以药物铺灸治疗，选取中脘穴区（涵盖任脉上脘至神阙一线，两侧至足少阴肾经），铺灸药物选择附子理中方，每日1次，每次约50 min，连续3 d为一疗程，每个疗程间隔1 d，共治疗3个疗程。比较两组化疗第1、3、7、14天恶心呕吐程度分级，观察两组治疗前及化疗第1、3、7、14天卡氏功能状态（KPS）评分，比较两组治疗前后中医症状分级和中医证候评分，评定两组临床疗效和安全性。结果：化疗第7、14天，观察组恶心程度分级低于对照组（P<0.05）；化疗第3、7、14天，观察组呕吐程度分级低于对照组（P<0.05,P<0.01）。与治疗前比较，两组患者化疗第1天和对照组患者化疗第7天KPS评分降低（P<0.05,P<0.01），观察组患者化疗第7天和两组患者化疗第14天KPS评分升高（P<0.01）。化疗第7、14天，观察组KPS评分高于对照组（P<0.01）。治疗后，两组患者各项中医症状分级优于治疗前（P<0.01）；除大便溏薄外，观察组各项中医症状分级优于对照组（P<0.05,P<0.01）。治疗后，两组中医证候评分均较治疗前降低（P<0.01），且观察组低于对照组（P<0.01）。观察组患者显效率为58.3%(21/36)，高于对照组的24.3%(9/37,P<0.01)。两组均无不良事件发生。结论：药物铺灸辅助治疗胃癌脾胃虚寒型CINV，可有效缓解恶心呕吐，改善中医症状，提高患者生存质量，临床疗效满意且安全性较好。

Objective To observe the clinical efficacy of herb-spreading moxibustion as an adjuvant treatment for chemotherapy-induced nausea and vomiting(CINV) of spleen and stomach deficiency cold in gastric cancer. Methods Seventy-six patients with CINV of spleen and stomach deficiency cold in gastric cancer were randomly divided into an observation group(38 cases, 1 case was discontinued, 1 case dropped out) and a control group(38 cases, 1 case was discontinued). The patients in both groups were treated with cisplatin+tigio regimen chemotherapy, and were treated with basic anti-nausea drugs on the 1st to 3rd day of chemotherapy. The observation group was treated with herb-spreading moxibustion at Zhongwan(CV12) acupoint area(covering from Shangwan [CV13] to Shenque [CV8] of the conception vessel, and from both sides to the kidney meridian of foot-shaoyin). The herb was selected as Fuzi Lizhong decoction, once a day, about 50 min each time, with 3 consecutive days as one treatment course, with an interval of 1 day between each course, for a total of 3 treatment courses. The grading of nausea and vomiting degree in the two groups were recorded on the 1st, 3rd, 7th and 14th days of chemotherapy. Karnofsky performance status(KPS) score in the two groups was observed before treatment and on the 1st, 3rd, 7th and 14th days of chemotherapy. The TCM symptom grading and TCM syndrome score of the two groups before and after treatment were compared, and the clinical efficacy and safety of the two groups were evaluated. Results On the 7th and 14th days of chemotherapy, the grading of nausea degree in the observation group was lower than that in the control group(P<0.05). On the 3rd, 7th and 14th days of chemotherapy, the grading of vomiting degree in the observation group was lower than that in the control group(P<0.05, P<0.01). Compared before treatment, the KPS scores of the two groups on the 1st day of chemotherapy and the control group on the 7th day of chemotherapy were decreased(P<0.05, P<0.01), and the KPS scores of the observation group on the 7th day of chemotherapy and the two groups on the 14th day of chemotherapy were increased(P<0.01). On the 7th and 14th days of chemotherapy, the KPS scores of the observation group were higher than those of the control group(P<0.01). After treatment, the each item grading of TCM symptom in the two groups was better than that before treatment(P<0.01), except for loose stool, the each item grading of TCM symptom in the observation group was better than that in the control group(P<0.05, P<0.01). After treatment, the scores of TCM syndrome in the two groups were lower than those before treatment(P<0.01), and the score in the observation group was lower than that in the control group(P<0.01). The obvious effective rate of the observation group was 58.3%(21/36), which was higher than 24.3%(9/37) of the control group(P<0.01). No adverse events occurred in both groups. Conclusion Herb-spreading moxibustion as an adjuvant treatment for CINV of spleen and stomach deficiency cold in gastric cancer can effectively relieve nausea and vomiting, and improve the symptoms of TCM, and improve the quality of life of patients. The clinical efficacy is satisfactory and the safety is good.