Ezzo J M, Richardson M A, Vickers A, Allen C, Dibble S L, Issell B F, Lao L, Pearl M, Ramirez G, Roscoe Ja, Shen J, Shivnan J C, Streitberger K, Treish I, Zhang G
James P. Swyers Enterprises, 1905 West Rogers Ave, Baltimore, Maryland 21209, USA.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD002285. doi: 10.1002/14651858.CD002285.pub2.
There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT(3) inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms.
The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.
We searched MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, and conference abstracts.
Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both.
Data were provided by investigators of the original trials and pooled using a fixed effect model. Relative risks were calculated on dichotomous data. Standardized mean differences were calculated for nausea severity. Weighted mean differences were calculated for number of emetic episodes.
Eleven trials (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% confidence interval 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% confidence interval 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD = -0.19; 95% confidence interval -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics.
AUTHORS' CONCLUSIONS: This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.
近期在使用5-羟色胺（5-HT）3抑制剂和地塞米松治疗化疗引起的恶心和呕吐方面取得了进展。然而，仍有许多患者会出现这些症状，专家小组鼓励采用更多方法来减轻这些症状。
评估穴位刺激对癌症患者急性和迟发性化疗引起的恶心和呕吐的有效性。
我们检索了MEDLINE、EMBASE、PsycLIT、MANTIS、科学引文索引、CCTR（Cochrane对照试验注册库）、Cochrane补充医学领域试验注册库、Cochrane疼痛、姑息治疗和支持治疗专业注册库、Cochrane癌症专业注册库以及会议摘要。
采用任何方法（针刺、电刺激、磁体或指压）进行穴位刺激并评估化疗引起的恶心或呕吐，或两者均评估的随机试验。
数据由原始试验的研究者提供，并使用固定效应模型进行汇总。对二分数据计算相对风险。对恶心严重程度计算标准化平均差。对呕吐发作次数计算加权平均差。
汇总了11项试验（N = 1247）。总体而言，所有方法联合进行穴位刺激可降低急性呕吐的发生率（相对风险=0.82；95%置信区间0.69至0.99；P = 0.04），但与对照组相比，对急性或迟发性恶心严重程度无影响。按方式分类，针刺刺激可降低急性呕吐的比例（相对风险=0.74；95%置信区间0.58至0.94；P = 0.01），但对急性恶心严重程度无影响。电针可降低急性呕吐的比例（相对风险=0.76；95%置信区间0.60至0.97；P = 0.02），但手针则无此效果；未报告针刺的迟发性症状。指压可降低急性恶心的平均严重程度（标准化平均差=-0.19；95%置信区间-0.37至-0.01；P = 0.04），但对急性呕吐或迟发性症状无影响。无创电刺激对任何结果均无益处。所有试验均使用了辅助药物性止吐药，除电针试验外，所有试验均使用了最先进的止吐药。
本综述补充了关于术后恶心和呕吐的数据，提示穴位刺激具有生物学效应。电针已证明对化疗引起的急性呕吐有益，但需要将电针与最先进的止吐药联合应用于难治性症状患者的研究，以确定其临床相关性。自我实施指压似乎对急性恶心有保护作用，且可轻松教授给患者，不过研究未设安慰剂对照。当患者接受最先进的药物性止吐治疗时，无创电刺激似乎不太可能产生临床相关影响。
