蔺莉 李婷 崔杰 李文英 姜俊峰 王玉虹 彭小娟

摘要：目的 觀察周围神经方手足浸泡联合甲钴胺片防治长春新碱化疗所致周围神经毒性（CIPN）的临床疗效。方法 采用随机数字表法将108例经长春新碱药物化疗的非霍奇金淋巴瘤患者分为治疗组、对照组、联合组各36例。3组均进行常规化疗（均首次使用CHOP、R-CHOP、H-CAVD方案），共6个周期。对照组于化疗同时予甲钴胺片，每次0.5 mg，每日3次，口服；治疗组在化疗同时予周围神经方手足浸泡，先手后足，每次20 min，每日2次；联合组在化疗同时予甲钴胺片及周围神经方，用法用量同前。均7 d为1个疗程，连续治疗6个疗程。于化疗2、4、6个周期评价3组CIPN发生率及程度，比较满意度。筛选周围神经毒性≥Ⅱ度、已暂停化疗、自愿加入巩固治疗研究的患者50例，交替入巩固治疗组、巩固对照组各25例，巩固对照组口服甲钴胺片，巩固治疗组予周围神经方手足浸泡，用法用量同前，连续治疗20 d，评价2组临床疗效及满意度。结果 化疗2个周期，治疗组与联合组CIPN发生率明显低于对照组（P<0.05）。化疗4个周期，联合组CIPN发生率明显低于对照组（P<0.01）；治疗组与联合组CIPN≥Ⅱ度的发生率明显低于对照组（P<0.05）。化疗6个周期，治疗组与联合组CIPN≥Ⅱ度的发生率明显低于对照组（P<0.01）。治疗组满意率明显高于对照组（P<0.01）。对CIPN≥Ⅱ度的患者巩固治疗，2组临床疗效比较差异无统计学意义（P>0.05）；巩固治疗组满意率明显高于巩固对照组（P<0.01）。结论 周围神经方手足浸泡联合甲钴胺片对减轻CIPN疗效显著，可提高患者生活质量。

关键词：周围神经方；甲钴胺；长春新碱；化疗所致周围神经毒性；手足浸泡

DOI：10.3969/j.issn.1005-5304.2018.11.004

中图分类号：R277.75 文献标识码：A 文章编号：1005-5304（2018）11-0015-04

Abstract： Objective To observe the clinical efficacy of prevention and treatment of chemotherapy induced peripheral neurpathy （CIPN） by vincristine via using TCM prescription of peripheral neuropathy hand-food soaking combined with mecobalamin. Methods Totally 120 patients with non-Hodgkin's lymphoma who all received chemotherapy drugs including vincristine were randomly divided into treatment group （36 cases）， control group （36 cases） and combined treatment group （36 cases）. All groups received routine treatment （all used CHOP， R-CHOP and H-CAVD plans for the first time）， for 6 cycles of chemotherapy. The control group was given mecobalamin at the same time， 0.5 mg each time， oral administration， three times a day. The treatment group was given TCM prescription of peripheral neuropathy hand-foot soaking at the same time， hands first and feet later， 20 minutes each time， twice a day. The combined treatment group was given TCM prescription of peripheral neuropathy and mecobalamin at the same time， the same as the former method. 7 days were set as one treatment course， and all the treatment lasted for 6 cycles of chemotherapy. The incidence and degree of CIPN were evaluated in 2， 4， and 6 cycles of chemotherapy， and the satisfaction was compared. 50 patients of CIPN degree ≥Ⅱ were screened， paused chemotherapy， and participated in consolidation treatment research. The 50 patients were assigned into treatment group （25 cases） and control group （25 cases）. The control group took oral mecobalamin， and the treatment group used TCM prescription of peripheral neuropathy hand-foot soaking； the methods were the same as former methods， for 20 d. Clinical efficacy and satisfaction of both groups were evaluated. Results After the second cycle of chemotherapy， the incidence of CIPN in the treatment group and the combined treatment group were obviously lower than the control group （P<0.05）. After the fourth cycle of chemotherapy， the incidence of CIPN in the combined treatment group were obviously lower than the control group （P<0.01）； the incidence of CIPN degree ≥Ⅱ in the treatment group and combined treatment group were obviously lower than the control group （P<0.05）. After the sixth cycle of chemotherapy， the incidence of CIPN degree ≥Ⅱ in the treatment group and combined treatment group were obviously lower than the control group （P<0.01）. The satisfaction rate of the treatment group was higher than the control group （P<0.01）. For the consolidation therapy to patients of CIPN degree ≥Ⅱ， there was no statistical significance in clinical efficacy between the treatment group and the control group （P>0.05）， but the satisfaction rate of the treatment group was higher than the control group （P<0.01）. Conclusion TCM prescription of peripheral neuropathy hand-food soaking combined with mecobalamin can obviously relieve CIPN degree induced by vincristine， and improve the life quality of patients.