加巴喷丁联合阿米替林治疗阿片耐受的重度癌痛的临床回顾性研究

发布时间：2018-07-13 09:59

【摘要】：目的通过回顾性研究,评价加巴喷丁联合阿米替林治疗阿片耐受(opioid tolerance)的重度癌痛(cancer pain)的临床疗效。方法以2015年9月至2016年9月间,德阳市人民医院肿瘤科诊断明确的仅能姑息对症治疗的阿片耐受的重度癌痛患者为研究对象。按接受的镇痛治疗方案分为两组,对照组29例:仅给予吗啡(吗啡缓释片、吗啡注射液)治疗;观察组28例:给予加巴喷丁、阿米替林及吗啡(吗啡缓释片、吗啡注射液)治疗。治疗目标为背景痛(background cancer pain)数字评分法(numberical rating scale,NRS)≤3分,两组患者均根据疼痛程度调整药物用量,当出现爆发痛(breakthrough pain,BTP)时采用盐酸吗啡注射液皮下注射。比较两组患者疼痛稳定后焦虑、抑郁、生存质量、日需吗啡量。结果 (1)焦虑、抑郁状态改善:与治疗前相比,两组患者焦虑、抑郁评分均下降(P0.05),但观察组较对照组下降更明显(P0.05);(2)日需吗啡量:相比治疗前,疼痛控制稳定需要增加一定量的吗啡,但观察组增加量较对照组少(P0.05);(3)生存质量:与治疗前相比,两组患者的躯体功能、角色功能及社会功能无明显改变(P0.05),但情绪功能改善(P0.05),对照组患者失眠、总健康较治疗前无明显改善(P0.05),且恶心呕吐、便秘、食欲丧失较治疗前症状加重(P0.05)。观察组失眠、食欲丧失、总健康得到改善(P0.05),恶心呕吐、便秘较治疗前无明显变化(P0.05)。结论加巴喷丁联合阿米替林不仅可增强吗啡对阿片耐受的重度癌痛的疼痛控制,且不增加恶心呕吐、便秘,还可以改善焦虑、抑郁、失眠和食欲丧失等症状,提高总健康评分。
[Abstract]:Objective to evaluate the clinical efficacy of gabapentin combined with amitriptyline in the treatment of severe cancerous (cancer pain) with opioid tolerance to (opioid tolerance). Methods from September 2015 to September 2016, the patients with severe opioid tolerance in Department of Oncology, Deyang people's Hospital, who could only be treated with palliative treatment, were studied. The control group (29 cases) received morphine (morphine sustained-release tablets, morphine injection) and the observation group (28 cases) received gabapentin, amitriptyline and morphine (morphine sustained-release tablets). Morphine injection) treatment. The target of treatment was (numberical rating scale-NRS 鈮，

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