低温压缩以减少妇科癌症的外周神经病变:一个随机对照试验
Mary Katherine Anastasio1, Shakthi Unnithan, Amelia Scott
1Department of Obstetrics and Gynecology, the Department of Biostatistics and Bioinformatics, the Department of Neurology, and the Duke Cancer Institute, Duke University Medical Center, and the Division of Gynecologic Oncology, Duke Cancer Institute, Durham, North Carolina.
Obstetrics and gynecology
|October 26, 2023
概括
在妇科癌症患者中,冷压缩疗法显著减少了化疗诱导的外周感官神经病变. 这种冷压缩干预被证明是有效和耐受良好,为控制神经毒性提供了一个有希望的策略.
科学领域:
- 在瘤学瘤学.
- 神经科学是一个神经科学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 化疗诱导的周围神经病变 (CIPN) 是一种常见的剂量限制性毒性.
- 目前对CIPN的管理策略有限,需要新的预防方法.
- 低温压缩疗法为CIPN提供了潜在的非药物干预.
研究的目的:
- 评估冷压缩疗法的有效性,以预防CIPN.
- 评估冷压缩对神经病变的主观和客观指标的影响.
- 为了确定冷压缩疗法的患者接受性和耐受性.
主要方法:
- 一个单一机构,随机,自我控制的试验招募了接受神经毒性化疗的妇科癌症患者.
- 患者在一侧 (主导手/脚) 接受冷压缩,并在相反侧面作为自己的对照.
- 低温压缩包括在化疗输注之前,期间和之后15分钟应用冷却装置.
主要成果:
- 低温压缩显著降低了感官神经病变的几率 (患者神经毒性问卷等级C或更高) 46% (OR 0.54,P=.03).
- 通过Semmes-Weinstein单丝试验,在冷压缩和对照侧之间没有观察到触觉灵敏度的显著差异.
- 使用FACT/GOG-NTX-11和FACT/GOG-NTX-4得分的患者报告的结局在冷压缩时显著改善 (P=.04和P=.02,分别).
结论:
- 低温压缩疗法有效地减少了妇科癌症患者的主观化疗诱导的外周感官神经病变.
- 超过85%的参与者认为这种干预是可以接受和容忍的.
- 低温压缩是一种可行的策略,可以缓解帕克利塔克塞尔或西斯普拉丁诱导的神经毒性.
相关概念视频
01:21Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
287
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
287
01:28Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
170
Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates...
170
01:26Peripheral Artery Disease IV: Nursing Management
11
The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
11
01:23Peripheral Artery Disease V: Postoperative Nursing Management
12
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
12
01:29Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists
305
Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...
Phenothiazines, such as prochlorperazine...
305
01:27Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
217
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
217