以實證觀點探討耳穴貼壓緩解癌症病人化學治療引發噁心及嘔吐之成效

An Evidence-based Approach: Effects of Auricular Acupressure on Relieving Chemotherapy-Induced Nausea and Vomiting in Cancer Patients

背景：噁心與嘔吐常見於接受化學治療的癌症病人，然而，止吐藥的治療效果有其限制，且並非沒有副作用。
目的：本文旨在以實證觀點探討耳穴貼壓緩解癌症病人化學治療引發噁心嘔吐之成效。
方法：六個資料庫包括PubMed、Cochrane Library、Embase、Medline、CINHAL及華藝線上圖書館，搜尋結果共識別67篇文獻。最後，2篇文章符合篩選條件，包括1篇隨機控制試驗文章及1篇系統性文獻回顧及統合分析文章，並依據牛津實證醫學中心的證據等級準則評定2篇文章分別為第二等級及第一等級。使用隨機控制試驗及系統性文獻回顧與統合分析之CASP檢核表評估實證品質。
結果：共計1563位癌症病人納入研究中，相較於只用止吐藥物，耳穴貼壓與止吐藥物併用可有效改善急性噁心發生率及嚴重度、延遲性噁心及嘔吐的頻率、化學治療引發噁心嘔吐之整體有效率。耳穴貼壓是一種安全且具有成本效益的介入措施，多數研究使用王不留行籽貼置於胃、神門、交感、脾、皮質下及肝等耳穴。
結論：耳穴貼壓與止吐藥物併用可更有效緩解癌症病人化療引發噁心嘔吐。然而，分配隱匿偏差、執行偏差、偵測偏差、小樣本數及試驗間的異質性，可能影響證據品質並降低結果精確性。未來臨床試驗應增加樣本數，並進行適當的分配隱匿及盲法程序，以提高證據的品質和精確性。

Background: Nausea and vomiting are high prevalent in cancer patients receiving chemotherapy. However, the therapeutic effect of antiemetic drugs is limited and is not free from side effects.
Purpose: This article uses an evidence-based approach and aims to investigate the effect of auricular acupressure (AA) on relieving chemotherapy-induced nausea and vomiting (CINV) in cancer patients.
Methods: A total of 67 articles were identified from the search results of 6 literature databases, including PubMed, Cochrane Library, Embase, Medline, CINHAL, and Airiti Library. Finally, two articles met the eligibility criteria, including one randomized controlled trial and one systematic review and meta-analysis. According to the Levels of Evidence of the Oxford Centre for Evidence-Based Medicine, they were classified as Levels 2 and 1, respectively. The Critical Appraisal Skills Programme (CASP) checklists for randomised controlled trial and systematic reviews with meta-analysis of randomised controlled trials were used to assess the quality of evidence.
Results: A total of 1,563 cancer patients were included in the studies. Compared with antiemetics alone, AA combined with antiemetics was effective in improving incidence and severity of acute nausea, the frequency of delayed nausea and vomiting, and the overall efficiency of CINV. AA is a safe and cost-effective intervention. In most studies, the Vaccaria seeds were attached to six auricular acupoints: stomach, shenmen, sympathetic, spleen, subcortical, and liver.
Conclusion: AA combined with antiemetics can be effective in relieving CINV in cancer patients. However, allocation concealment bias, performance bias, detention bias, small sample size, and betweentrials heterogeneity may impact the quality of evidence and reduce the precision of results. Future clinical trials should increase sample size and conduct appropriate allocation concealment and blinding procedures to improve the quality of evidence and precision.