接受化療之兩位白血病病童胃肌電活動與噁心／嘔吐之初探

A Pilot Study: Gastric Motility and Nausea/Vomiting in Two Leukemia Children Receiving Chemotherapy

本研究目的為確認二位白血病病重之化療引致噁心／嘔吐與胃肌電活動之變化。十歲吳小弟為白血病復發病重，住院期間每天六小時連續三天接受靜脈注射1.1gm Cytarabine，同時每天給予止吐藥Tropisetron 5 mg24小時靜脈輸注；八歲王小妹診斷為白血病，接受TPOG 93HR引導期化療，注射藥物包括Epirubicin、Vincristin、L-asparaginase及Prednisolone，在化療的第一天給予止吐藥Tropisetron 5mg。病童每天於化療前二小時直至化療後四小時，以不具侵入性的胃肌電波監測儀連續記錄七天共42小時之胃肌電活動變化；並同步以數位錄影機記錄病重的姿勢、動作與活動。資料收集期間共有四件噁心與嘔吐事件發生，資料分析在去除活動雜訊後，以頻譜分析噁心和嘔吐前、後的胃肌電活動變化。結果發現兩次的噁心事件中有53~10.3%的胃波過慢及21~10.3%的胃波過快；兩次的嘔吐前之胃肌電活動變化分別有85.8%與100%的胃正常慢波；而嘔吐後則各有3.4%與12.2%的胃波過快發生。此生理測量指標之研究結果有助於臨床醫護人員瞭解癌症病童引致嘔吐症狀、其他腸胃不適或控制噁心嘔吐症狀之參考。本個案研究之活動雜訊如：姿勢、動作及活動與胃肌電活動變化的關係是在資料收集時必需要考量的。

The purpose of the study was to identify the association between chemotherapy-induced nausea/vomiting and changes to the electrogastrogram (EGG) of two children suffering from leukemia. After receiving written consent/assent, the children, both with acute lymphoblastic leukemia (ALL), were recruited. One of the subjects, a ten year-old boy, was given 1.1 gm Cytarabine (intravenous infusion for six hours per day) for three days and Tropisetron 5 mg intravenous infusion for 24 hours. The other subject, an eight year-old girl, received the induction phase of TPOG 93HR chemotherapy, which included Epirubicin, Vincristin, L-asparaginase, and Prednisolone and Tropisetron 5 mg on Day 1. The EGG recordings of both patients were recorded for a total of 42 hours by cutaneous electrogastrography over a seven day period. This included two-hour and four-hour readings taken before and immediately following the administration of chemotherapy each day. The position, movements, and activities of the children while on the EGG were recorded on digital video. Four episodes of nausea and vomiting were detected during this period. Pre- and post-nausea and vomiting during the EGG were analyzed using spectrum analysis after the deletion of motion artifacts. The findings of this study indicated that two episodes of nausea were 5.3~10.3% bradygastria and 2.1~0.3% tachygastria, with 85.8% and 100% normal gastric slow waves detected by EGG during the pre-vomiting period. Tachygastria was present in 3.4% and 12.2% of the post-vomiting period of each episode. The association of artifacts with position, movement, and activities must be considered during data collection.