120例癌性疼痛相关因素分析及益肾骨康方治疗骨转移癌癌性疼痛临床疗效研究

发布时间：2018-01-31 00:34

本文关键词： 骨转移癌癌性疼痛益肾骨康方影响因素　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分:癌痛程度的影响因素研究研究目的本研究通过采集癌痛患者的相关资料,分析癌痛程度的影响因素,探讨其干预策略,为其综合治疗提供思路。研究方法本研究属于描述性研究,收集患者资料,包括一般状况、Karnofsky功能状态评分标准、数字疼痛强度等。以癌痛程度为因变量,运用SPSS软件分析其他指标与癌痛程度之间的相关性。研究结果本研究收集120例癌痛患者,其中中度疼痛70例,重度疼痛50例。将患者分为62岁以下(含62岁)和62岁以上,年龄与癌痛程度有关。癌痛病程与癌痛程度有关,中度疼痛患者癌痛病程半年以下的有44例(62.86%),重度疼痛患者中癌痛病程半年以下的有23例(46%);而有91.43%的中度疼痛患者癌痛病程在一年以下,重度疼痛患者中只有70%,甚至有6例患者癌痛病程长达3年。本研究120例癌痛患者中有73例(60.83%)有过癌痛治疗史,但是治疗史与癌痛程度无关。爆发痛次数与癌痛程度有关。重度疼痛患者中爆发痛次数达3次及以上的为48例,占96%,明显高于中度疼痛的38例,54.3%。肿瘤骨转移可加重癌痛程度。本研究中共27例肿瘤骨转移患者,其中有20例重度癌痛,占重度疼痛患者的40%。KPS评分与癌痛程度有关。研究结论(1)单变量分析结果显示,年龄、癌痛病程、爆发痛次数、是否有骨转移、KPS评分与癌痛程度有关;(2)二元Logistic回归分析结果显示,KPS评分、爆发痛次数、是否有骨转移与癌痛程度有关。第二部分:益肾骨康方治疗骨转移癌癌性疼痛的临床疗效研究研究目的观察扶正解毒化瘀中药益肾骨康方联合三阶梯止痛药盐酸羟考酮缓释片对骨转移癌疼痛患者的临床疗效和安全性。研究方法按照诊断标准共收集88例骨转移癌疼痛患者,采用双盲、随机对照试验分为治疗组和对照组各44例。治疗组给予盐酸羟考酮缓释片和中药益肾骨康方,对照组给予盐酸羟考酮缓释片和治疗组中药剂量10%的安慰剂治疗。两组治疗14天后对疼痛影响评分、NRS评分、KPS评分、盐酸羟考酮用量等主要指标进行治疗前后组内和组间比较,综合评价临床疗效。研究结果治疗组临床总有效率为82%明显优于对照组的38.6%(P0.01)。治疗组和对照组都可以减少NRS评分和爆发痛次数,减少单日盐酸羟考酮用量,且优于对照组。治疗前后,治疗组可以显著提高患者KPS评分(P0.01),而对照组治疗前后KPS评分变化不显著(P=0.302),但是两组差异无统计学意义。在疼痛影响评分方面,治疗后两组各项评分均有所下降,而治疗组比对照组在"情绪"(P=0.009)和"睡眠"(P=0.025)两个方面有一定疗效。治疗组和对照组安全性评价良好,无明显不良反应和毒副作用。研究结论中药益肾骨康方联合三阶梯止痛药盐酸羟考酮缓释片治疗骨转移癌疼痛,较单纯应用盐酸羟考酮缓释片治疗具有更好的止痛效果,可以改善临床症状,且安全性高。
[Abstract]:The first part: research on the influencing factors of cancer pain objective this study analyzed the influencing factors of cancer pain by collecting the relevant data of cancer pain patients and discussed its intervention strategy. Methods this study is a descriptive study, collecting data of patients, including general status of Karnofsky functional state score. Digital pain intensity and so on. With cancer pain degree as a dependent variable, SPSS software was used to analyze the correlation between other indicators and cancer pain degree. Results 120 patients with cancer pain were collected in this study. There were 70 cases of moderate pain and 50 cases of severe pain. The patients were divided into two groups: under 62 years old (including 62 years old) and over 62 years old. The age was related to the degree of cancer pain, and the course of cancer pain was related to the degree of cancer pain. There were 44 cases with cancer pain less than half a year in moderate pain patients and 23 cases with cancer pain course less than half a year in severe pain patients. The course of cancer pain was less than one year in 91.43% patients with moderate pain and 70% patients with severe pain. There were even 6 patients with cancer pain for 3 years. In this study, 73 out of 120 patients with cancer pain had a history of cancer pain treatment. But the history of treatment was not related to the degree of cancer pain. The frequency of pain outbreak was related to the degree of cancer pain. Among the patients with severe pain, 48 cases (96%) had three or more outbreaks of pain, which was significantly higher than that of 38 cases of moderate pain. 54.3. Tumor bone metastasis can aggravate the degree of cancer pain. In this study, there were 27 patients with tumor bone metastasis, including 20 patients with severe cancer pain. KPS score in patients with severe pain is related to the degree of cancer pain. Conclusion 1) univariate analysis results show that age, course of cancer pain, number of pain outbreaks, whether there is bone metastasis. The KPS score was related to the degree of cancer pain. 2) the results of binary Logistic regression analysis showed that the score of KPS and the number of pain outbreaks. Whether there is bone metastasis is related to the degree of cancer pain. Part two:. Clinical study on the effect of Yishen Gu Kang recipe on Cancer pain caused by Bone Metastasis objective to observe the clinical treatment of pain patients with bone metastasis cancer treated by Yishen Gu Kang recipe combined with three ladder analgesic hydroxy codone sustained release tablets. Methods 88 patients with pain of bone metastatic carcinoma were collected according to the diagnostic criteria. A double-blind, randomized controlled trial was used to divide the treatment group into treatment group (n = 44) and control group (n = 44). The treatment group was given hydroxycodone hydrochloride sustained release tablets and Yishen Gu Kang prescription. The control group was treated with hydroxycodone hydrochloride sustained release tablets and the treatment group was treated with placebo of 10% Chinese medicine dosage. After 14 days of treatment, the pain impact score was evaluated with NRS score and KPS score in both groups. The dosage of hydroxycodone hydrochloride and other main indexes were compared before and after treatment. Results the total effective rate of the treatment group was 82% significantly better than that of the control group (38.6% P0.01). Both the treatment group and the control group reduced the NRS score and the number of pain outbreaks. Before and after treatment, the KPS score of the patients in the treatment group was significantly increased (P 0.01). In the control group, there was no significant change in KPS score before and after treatment, but there was no significant difference between the two groups. In terms of pain impact score, each score of the two groups decreased after treatment. The treatment group was more effective than the control group in two aspects: "emotion" (P0. 009) and "sleep" (P0. 025). The safety of the treatment group and the control group was good. There were no obvious adverse reactions and side effects. Conclusion Yishen Gu Kang prescription combined with three ladder analgesic hydroxycodone sustained release tablets for pain of bone metastases cancer. Compared with hydroxycodone hydrochloride sustained-release tablets alone, it has better analgesic effect, can improve clinical symptoms, and has high safety.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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