穴位埋线背俞穴联合三阶梯止痛法治疗中重度癌痛的临床观察

发布时间：2018-03-02 02:17

本文关键词： 癌性疼痛三阶梯止痛方法脊神经节段分布背俞穴穴位埋线生存质量医院焦虑抑郁状态　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景：癌症患者自觉的癌性疼痛,主要指肿瘤细胞的浸润、扩散、转移或压迫相关组织所引起的,是众多症状中发生率最高的。尽管有“三阶梯止痛”国际公认的方法来治疗癌痛,但仍未能做到控制所有的癌痛。穴位埋线疗法具有镇痛效果重、刺激效力长、不需反复操作的优势。为了进一步探寻治疗癌痛更好的手段,所以我们按脊神经节段分布选择背俞穴位埋线疗法在癌痛治疗上进行探索其作用。目的：本课题将从临床角度通过对癌痛患者在“三阶梯止痛方法”基础上,并结合脊神经节段分布选择背俞穴,与单纯使用“三阶梯止痛方法”进行疗效的对比,评估两组疼痛缓解的情况以及对生命质量、医院焦虑抑郁的影响,为穴位埋线背俞穴治疗癌性疼痛提供临床的依据。方法：采用队列研究的设计原则,通过四个标准：诊断、纳入、排除、脱落标准后,在广州中医药大学第一附属医院观察肿瘤中心住院部的60例中、重度癌痛患者。按照患者的意愿分为试验组(30例)及对照组(30例),对照组单纯以“三阶梯止痛方法”给药,NRS评分4至6分,属于中度疼痛,使用药物为曲马多缓释片(100mg/片),1次/片,Q12H；NRS评分7至10分,属于重度疼痛,使用药物为盐酸羟考酮控释片(10mg/片),1次/片,Q12H；或者硫酸吗啡缓释片(30mg/片),1次/片,Q12H；或者芬太尼透皮贴剂(4.2mg/片),1次／贴,Q72H。若控制不理想,则根据疼痛缓解的程度予以剂量滴定,直到疗效满意。试验组则在此基础上,加上按脊神经节段分布选择背俞穴埋线,每周1次。并予记录每日的NRS评分,于治疗前及治疗后第7天予EORCT-QLQ-C30量表评价患者生存质量,及医院焦虑抑郁量表(HADS量表)来评估治疗前及治疗后第7天癌痛患者客观疼痛的改变。结果：分析结果表明,“试验组”比较“对照组”,第3天疼痛缓解率具有统计学差异(P0.05)。第7天后评价两组生活质量,与治疗前相比,功能领域中躯体、角色、认知、社会功能及主要症状领域中疲倦、疼痛、失眠及食欲的分值都有所提高,具有统计学差异(P0.05)。治疗后第7天,试验组和对照组的生活质量量表评分上比较可以看出两者在主要症状领域中,试验组对于疲倦及失眠的改善方面优于对照组,具有统计学差异(P0.05),而剩余比如总健康状况子量表、功能领域及大部分主要症状领域中,并不存在统计学差异(P0.05)。治疗前后给予HADS自评量表评价,本研究表明治疗后患者的焦虑抑郁情绪较治疗前好转,是具有统计学差异(P0.05)。结论：1.以脊神经节段分布选择背俞穴位埋线联合三阶梯止痛方法,可以提高有效率,显示背俞穴位埋线联合三阶梯组可能比较有优势。2.以脊神经节段分布选择背俞穴位埋线可以减少三阶梯止痛方法的副作用。3.有效的止痛可以提高患者的生存质量。4.癌痛患者多伴有焦虑抑郁状态,有效的止痛法可以缓解患者的焦虑抑郁状态。
[Abstract]:Background: the consciousness of cancer patients with cancer pain, mainly refers to the tumor cell invasion, proliferation, metastasis or oppression caused by the relevant organizations, is the highest incidence of many symptoms. Despite the three step analgesic ladder internationally recognized methods in treating cancer pain, but still failed to control all the pain. The acupoint catgut embedding therapy has the analgesic effect, stimulating effect, without repeated operation advantages. In order to further explore the treatment of cancer pain better means, so we choose according to the spinal ganglion segment distribution of Beishu acupoint catgut embedding therapy to explore its role in the treatment of cancer pain. Objective: this topic will be from a clinical perspective based on cancer patients based on "method" three step, combined with spinal ganglion segment distribution choice Beishu, compared with simply using the method of three step analgesic ladder for efficacy assessment, two groups of pain relief to And the influence on the quality of life, the hospital anxiety and depression, and provide clinical basis for Beishu acupoint catgut embedding for treatment of cancer pain. Methods: a cohort study design principle, through four criteria: diagnosis, inclusion, exclusion, shedding standard, tumor center of inpatient department in the First Affiliated Hospital of Guangzhou University of Chinese Medicine in 60 cases in patients with severe pain. According to the wishes of patients were divided into experimental group (30 cases) and control group (30 cases), the control group were treated with "method" three steps analgesic drug, NRS score of 4 to 6, belonging to moderate pain, the use of drugs for tramadol sustained-release tablets (100mg/ tablet), 1 times / tablet Q12H; NRS score 7 to 10 points, belong to severe pain, the use of drugs for oxycodone hydrochloride controlled-release tablets (10mg/ tablet), 1 /, Q12H; or Morphine Sulfate Sustained-release Tabelets (30mg/), 1 /, Q12H; or Fentany Transdermal System (4.2mg/), 1 / Q72H. if the control stick, Not ideal, according to the degree of pain relief to be dose titration, until satisfactory curative effect. The experimental group on the basis of which, coupled with spinal segment distribution choice Beishu catgut embedding, 1 times a week. And recorded daily NRS score, EORCT-QLQ-C30 scale to evaluate the life quality of the patients in the seventh days before and after treatment to, and the hospital anxiety and Depression Scale (HADS scale) to evaluate the change of seventh days in patients with cancer pain objective pain before and after treatment. Results: the analysis results show that the "experimental group" "control group", the third day pain relief rate was statistically difference (P0.05). Evaluation of quality of life of the two groups of seventh days later, compared with before treatment, the body function in the field of role cognition, fatigue, social function and main symptoms in the field of pain, insomnia and appetite scores are improved, with statistical difference (P0.05). Seventh days after treatment, the test group and the control The quality of life scores on the comparison between them can be found in the main symptoms in the field, the experimental group for fatigue and insomnia improvement than the control group, with statistical difference (P0.05), and the remaining for the overall health status scale, functional areas and most of the main symptoms in the field, there is no statistical difference (P0.05) before and after the treatment. HADS self rating scale evaluation, this study shows that after the treatment of anxiety and depression were better than those before treatment, with statistical difference (P0.05). Conclusion: 1. the spinal ganglion segment distribution choice Beishu acupoint catgut embedding therapy combined with three step method, can improve the efficiency of display, back Shu acupoint catgut embedding therapy combined with the three step group may have side effects.2. selection Beishu acupoint catgut embedding method can reduce the pain by three step spinal ganglion segment distribution of.3. effective analgesia can improve survival The patients with mass.4. cancer pain are mostly associated with anxiety and depression, and effective analgesic method can relieve the state of anxiety and depression.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R730.5

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