杨静雯 车文文 王平 潘战宇 夏小军 王斌 姜小燕 王丹 吕中茜 潘兴芳 陈泽林 郭永明 史丽萍 陈波 郭义

摘要 目的：探索針灸防治化疗后恶心的临床应用方案，为制定临床实践指南提供依据。方法：通过计算机检索国家知识基础设施数据库（CNKI）、中文科技期刊数据库（CCD）和Pubmed等数据库收集针灸治疗化疗后恶心的现代文献证据，使用Jadad评分量表、GRADE和Review Manager进行质量评价;通过人工检索49本古代医籍中针灸治疗恶心、哕、呃逆相关条文收集古代文献证据，采用古代文献证据分级方法进行评价;通过制定发放《针灸干预肿瘤不良反应调查问卷》，收集针灸干预化疗后恶心的临床一线专家经验。“以古代文献为基础，以现代文献为依据，以专家经验为参考”综合考虑，形成推荐方案。结果：现代文献纳入单穴处方RCT文献16篇;古代文献纳入针灸治疗恶心条文88项;发放问卷2次，回收52份专家反馈结果。综合3方面结果，发现针灸治疗化疗后恶心常用毫针刺法、穴位按压、经皮穴位电刺激、穴位注射，常用穴位为内关、涌泉、足三里。结论：形成针灸防治化疗后恶心的临床推荐应用方案，毫针刺法、穴位按压推荐选用内关，经皮穴位电刺激推荐选用内关、涌泉，穴位注射推荐选用足三里、内关。

关键词 针灸;化疗后恶心;临床实践指南;证据整合与推荐;肿瘤消化道反应;穴位按压;经皮穴位电刺激;穴位注射

Abstract Objective：To explore the clinical application of acupuncture and moxibustion to prevent and treat nausea after chemotherapy，and provide a basis for the formulation of clinical practice guidelines.Methods：Modern literature evidence was collected through computer search of National Knowledge Infrastructure Database（CNKI），Chinese Science and Technology Journal Database（CCD），Pubmed and other databases to collect modern literature evidence of nausea after acupuncture and moxibustion treatment after chemotherapy，and Jadad score scale，GRADE and Review Manager were used for quality evaluation; manual retrieval of 49 books acupuncture and moxibustion treatment of nausea，hiccups，and hiccups in ancient medical books to collect evidence from ancient literature，and we used ancient literature evidence grading methods for evaluation; through the formulation and distribution of the Acupuncture Intervention on Tumor Adverse Reaction Questionnaire，we collected the clinical experience of first-line experts on acupuncture and moxibustion intervention for nausea after chemotherapy.“Based on ancient documents，modern documents as the basis，and expert experience as a reference” which were comprehensively considered，we formed a recommended plan.Results：Modern literature included 16 single-point prescription RCT literature; ancient literature included 88 papers on acupuncture and moxibustion treatment of nausea; questionnaires were issued twice，and 52 expert feedback results were collected.Based on the results of the 3 aspects，it was found that acupuncture and moxibustion were commonly used in the treatment of nausea after chemotherapy were filiform acupuncture，acupoint pressing，transcutaneous electrical acupoint stimulation，and acupoint injection.The common acupoints are Neiguan（P6），Yongquan（K1），and Zusanli（S36）.Conclusion：The clinical recommended application scheme of acupuncture for prevention and treatment of nausea after chemotherapy is formed.Neiguan（P6）is recommended for filiform acupuncture and acupoint pressing，Neiguan（P6）and Yongquan（K1）are recommended for transcutaneous acupoint electrical stimulation.Zusanli（S36）and Neiguan（P6）are recommended for acupoint injection.

Keywords Acupuncture and moxibustion;Nausea after chemotherapy;Clinical practice guidelines; Evidence integration and recommendation;Tumor digestive tract response;Acupoint compression; Percutaneous acupoint electrical stimulation;Acupoint injection

中图分类号：R245;R273文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.10.021

2016年，癌症支持疗法多国学会（Multinational Association of Supportive Care in Cancer，MASCC）与欧洲肿瘤内科学会（European Society of Medical Oncology，ESMO）发布了一项指南——《放化疗相关性恶心呕吐以及晚期肿瘤患者恶心呕吐的预防》，指出化疗后恶心是目前癌症化疗患者最为痛苦的不良反应之一[1]。……