肿瘤化疗患儿延迟性恶心呕吐的影响因素分析

doi:10.3761/j.issn.0254-1769.2023.20.009

摘要/Abstract

摘要：

目的探讨肿瘤化疗患儿延迟性恶心呕吐的发生情况及影响因素，为护理人员制订居家照护方案提供依据。方法该研究为前瞻性队列研究，连续选取2022年8月—10月在浙江省某三级甲等儿童专科医院化疗的肿瘤患儿及其照护者作为调查对象，采用巴克斯特干呕脸量表、美国卫生及公共服务部呕吐严重程度评估标准调查患儿延迟性恶心呕吐的发生情况，使用延迟性恶心呕吐影响因素调查表收集相关影响因素，采用二分类Logistic逐步回归进行分析。结果共纳入378例肿瘤化疗患儿，其中229例（60.6%）发生延迟性恶心，144例（38.1%）发生延迟性呕吐，延迟性呕吐主要发生在化疗后1~2 d（50.7%）。Logistic回归分析显示，体表面积、化疗结束后有无负性情绪、有无延迟性恶心呕吐史、是否处于吸烟环境是肿瘤化疗患儿延迟性恶心的影响因素（P<0.05）；体表面积、有无延迟性恶心呕吐史、是否合并呼吸或消化系统疾病、化疗药物致吐风险、是否处于吸烟环境、肿瘤类型是肿瘤化疗患儿延迟性呕吐的影响因素（P<0.05）。结论肿瘤化疗患儿延迟性恶心呕吐的发生率较高，尤其在化疗结束后1~2 d。体表面积大、化疗结束后有负性情绪、有延迟性恶心呕吐史是肿瘤化疗患儿发生延迟性恶心的危险因素；体表面积大、有延迟性恶心呕吐史、合并呼吸或消化系统疾病、化疗药物致吐风险高、罹患实体肿瘤是肿瘤化疗患儿发生延迟性呕吐的危险因素。建议护理人员根据相关危险因素制订预防措施，开展居家照护指导，以降低肿瘤化疗患儿延迟性恶心呕吐的发生率。

关键词: 肿瘤, 化疗, 恶心呕吐, 影响因素分析, 儿科护理学

Abstract:

Objective To explore the occurrence and influencing factors of delayed nausea and vomiting in children with tumor chemotherapy，so as to provide bases for doctors and nurses to formulate home care plans. Methods A prospective cohort study was conducted，and a toll of consecutive children who received chemotherapy and their caregivers in a tertiary A Children’s Hospital in Zhejiang Province from August to October 2022 were enrolled as the subjects of investigation. Baxter Retching Faces Scale and United States Department of Health and Human Services Common Adverse Event evaluation criteria were used to evaluate the incidence of delayed nausea and vomiting. The influencing factors of delayed nausea and vomiting were collected by questionnaire and analyzed by binary logistic stepwise regression. Results A total of 378 children with tumor chemotherapy were included，of which 229（60.6%） developed delayed nausea and 144（38.1%） developed delayed vomiting. Delayed vomiting mainly occurred 1-2 days after chemotherapy（50.7%）. Logistic regression analysis showed that body surface area，negative emotion，history of delayed nausea and vomiting，and smoking environment were the influencing factors of delayed nausea in children with tumor chemotherapy. Body surface area，history of delayed nausea and vomiting，complicated with respiratory or digestive system diseases，vomiting risk of chemotherapeutic drugs，smoking environment and tumor type were the influencing factors of delayed vomiting in children with tumor chemotherapy （P<0.05）. Conclusion The incidence of nausea and vomiting associated with delayed chemotherapy was high in children with tumor，especially at 1~2 days after chemotherapy. Large body surface area，negative emotion and history of delayed nausea and vomiting are the high-risk factors of delayed nausea in children with tumor chemotherapy；large body surface area，history of delayed nausea and vomiting，complicated with respiratory or digestive system diseases，high vomiting risk of chemotherapeutic drugs and solid tumors are high risk factors for delayed vomiting in children undergoing tumor chemotherapy. It is suggested that medical staff should formulate preventive measures according to relevant risk factors and carry out home care guidance to reduce the incidence of delayed nausea and vomiting in children undergoing tumor chemotherapy.

Key words: Neoplasms, Chemotherapy, Nausea and Vomiting, Root Cause Analysis, Pediatric Nursing

虞露艳, 林楠, 周莹, 白冠男, 何昕彧, 褚小艺, 张怡然, 吴倩, 赵丹, 郭梦颖, 诸纪华. 肿瘤化疗患儿延迟性恶心呕吐的影响因素分析[J]. 中华护理杂志, 2023, 58(20): 2494-2502.

YU Luyan, LIN Nan, ZHOU Ying, BAI Guannan, HE Xinyu, CHU Xiaoyi, ZHANG Yiran, WU Qian, ZHAO Dan, GUO Mengying, ZHU Jihua. Analysis of influencing factors and nursing countermeasures of delayed nausea and vomiting in children with tumor chemotherapy[J]. Chinese Journal of Nursing, 2023, 58(20): 2494-2502.

图/表 3

表1 肿瘤化疗患儿延迟性恶心呕吐影响因素的单因素分析结果（n=378）

Table 1 Results of univariate analysis of nausea and vomiting associated with delayed chemotherapy in children with tumors（n=378）

表2 自变量赋值方式

Table 2 Independent variable assignment method

表3 肿瘤化疗患儿延迟性恶心呕吐影响因素的Logistic回归分析结果

Table 3 Logistic regression analysis of factors affecting nausea associated with delayed chemotherapy in children with tumors

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