难治性化疗相关性恶心呕吐防治的天津专家共识（2025版）

doi:10.11958/20240783

摘要/Abstract

摘要：

恶心呕吐是化疗最常见的不良反应。近年来随着肿瘤姑息和支持治疗的不断进步，化疗相关性恶心呕吐（CINV）的防控率得到了有效改善，但仍有少部分患者的CINV在接受预防和解救治疗后仍不能获得满意控制或者反复发生，成为难治性CINV。难治性CINV是目前肿瘤治疗领域非常棘手的问题，严重影响患者的生活质量、化疗的进程及预后。因此，天津市抗癌协会癌症康复与姑息治疗专业委员会、天津市医师协会肿瘤多学科诊疗（MDT）专业委员会组织专家制定了难治性CINV防治的天津专家共识，对难治性CINV的概念、评估、防治策略、用药指导、中医治疗、护理、MDT管理模式进行汇总，并给予相应推荐，以期为完善临床难治性CINV的预防和诊治提供更多可供参考的依据。该共识对难治性CINV仅提供学术性指导意见，具体实施方案需根据临床实际情况确定。

关键词: 恶心, 呕吐, 难治性恶心呕吐, 化疗相关性恶心呕吐, 防治, 共识

Abstract:

Nausea and vomiting are the most common adverse reactions of chemotherapy. In recent years, with the progression of palliative and supportive care, the prevention and control rate of chemotherapy induced nausea and vomiting (CINV) have been effectively improved. However, a small number of CINV still cannot be controlled satisfactorily or recurrence after receiving CINV prevention and treatments, which gradually develops into refractory CINV. Refractory CINV is a very difficult problem in the field of supportive care, which seriously affects the quality of life of patients, chemotherapy progress and prognosis. Therefore, Tianjin Anti-Cancer Association Committee of Rehabilitation and Palliative Care and Tianjin Medical Doctor Association Committee of Tumor Multidisciplinary Diagnosis and Treatment (MDT) organized experts to formulate a Tianjin expert consensus on the prevention and treatment of refractory CINV. The concept of refractory CINV, prevention and treatment strategies, specific medication guidance, traditional Chinese medical treatments, nursing and MDT management are summarized. Meanwhile, the corresponding recommendations are also given in order to provide more reference for improving the prevention and treatment of refractory CINV. This consensus only provides academic guidance for refractory CINV, the specific implementation plans need to be determined based on actual clinical conditions.

Key words: nausea, vomiting, refractory nausea and vomiting, chemotherapy induced nausea and vomiting, prevention and treatment, consensus

中图分类号:

R453，R730.5

图/表 1

参考文献 38

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项目名称	证据等级	描述	研究类型
证据分级	高级证据	非常确信真实的效应值接近效应估计	随机对照试验（RCT）；质量升高2级的观察性研究
	中级证据	对效应估计值有中等程度的信心：真实值有可能接近估计值，但仍存在二者大不相同的可能性	质量降低1级的RCT；质量升高1级的观察性研究
	低级证据	对效应估计值的确信程度有限：真实值可能与估计值大不相同	质量降低2级的RCT；观察性研究
	极低级证据	对效应估计值几乎没有信心：真实值很可能与估计值大不相同	质量降低3级的RCT；质量降低1级的观察性研究；系列病例观察；个案报道
推荐强度	强	明确显示干预措施利大于弊或弊大于利
推荐强度	弱	利弊不确定或无论质量高低的证据均显示利弊相当

项目名称	证据等级	描述	研究类型
证据分级	高级证据	非常确信真实的效应值接近效应估计	随机对照试验（RCT）；质量升高2级的观察性研究
	中级证据	对效应估计值有中等程度的信心：真实值有可能接近估计值，但仍存在二者大不相同的可能性	质量降低1级的RCT；质量升高1级的观察性研究
	低级证据	对效应估计值的确信程度有限：真实值可能与估计值大不相同	质量降低2级的RCT；观察性研究
	极低级证据	对效应估计值几乎没有信心：真实值很可能与估计值大不相同	质量降低3级的RCT；质量降低1级的观察性研究；系列病例观察；个案报道
推荐强度	强	明确显示干预措施利大于弊或弊大于利
推荐强度	弱	利弊不确定或无论质量高低的证据均显示利弊相当