What treatment options are available for severe diarrhea in a patient undergoing third-round chemotherapy for gastric cancer?

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From the Guidelines

胃癌术后化疗第三轮出现严重腹泻时,首先应采取口服补液、饮食调整和使用洛哌丁胺(Loperamide)4mg初始剂量,之后每次松弛便后2mg,最大日剂量不超过16mg的治疗方法。此外,应避免皮肤刺激,并通知治疗医生1。如果洛哌丁胺无法控制腹泻,医生可能会开处方奥曲肽(Octreotide)1。保持水分平衡,遵循BRAT饮食(香蕉、米饭、苹果酱、吐司),避免辛辣、油腻、乳制和高纤维食物,也有助于缓解症状。益生菌如乳酸杆菌或酵母菌可以帮助恢复肠道菌群1。如果出现发热、严重腹痛、便血或脱水征象,应立即联系肿瘤医生,因为化疗引起的腹泻可能很严重,医生可能需要调整化疗剂量或安排以控制症状。这种方法既能管理症状,又能解决化疗药物对肠道黏膜的破坏,影响正常的吸收和分泌。

From the FDA Drug Label

Octreotide acetate injection is indicated for the symptomatic treatment of patients with metastatic carcinoid tumors where it suppresses or inhibits the severe diarrhea and flushing episodes associated with the disease. Octreotide acetate injection is indicated for the treatment of the profuse watery diarrhea associated with VIP-secreting tumors.

治疗方法是使用奥曲肽(octreotide),它可以抑制或减轻与疾病相关的严重腹泻和潮红发作。对于胃癌术后化疗第三轮出现的严重腹泻,奥曲肽 可能是一种有效的治疗选择 2

  • 主要作用:抑制或减轻严重腹泻
  • 适用范围:包括与 癌症 相关的腹泻症状。

From the Research

胃癌术后化疗第三轮,腹泻比较严重的治疗方法

  • 根据研究3,奥曲肽(octreotide)比洛哌丁胺(loperamide)更有效地治疗化疗引起的腹泻,80%的患者在4天内完全缓解了腹泻。
  • 研究4表明,奥曲肽长效制剂(octreotide LAR)可以有效地缓解化疗引起的腹泻,并且可以预防进一步的腹泻发作。
  • 研究5发现,奥曲肽可以在3天内完全缓解94%的患者的化疗引起的腹泻,无明显副作用。
  • 研究67也支持奥曲肽在治疗化疗引起的腹泻方面的有效性,尤其是在洛哌丁胺治疗失败后的情况下。

奥曲肽的使用方法

  • 根据研究3,奥曲肽可以通过皮下注射0.5mg,三次 denně,直到腹泻完全缓解。
  • 研究5建议奥曲肽可以通过皮下注射100微克,三次 denně,连续3天,然后减少到50微克,三次 denně,连续3天。
  • 研究46表明,奥曲肽长效制剂(octreotide LAR)可以通过肌肉注射30mg,毎28天一次,来预防化疗引起的腹泻。

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Resolution of refractory chemotherapy-induced diarrhea (CID) with octreotide long-acting formulation in cancer patients: 11 case studies.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2004

Research

Octreotide in the treatment of severe chemotherapy-induced diarrhea.

Annals of oncology : official journal of the European Society for Medical Oncology, 2001

Research

Octreotide versus loperamide in the treatment of fluorouracil-induced diarrhea: a randomized trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1993

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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