中药外敷抗癌止痛贴联合针刺三阶梯药物止痛法治疗癌症疼痛的临床研究

Clinical Study on Treatment of Cancer Pain by External Application of Anti Cancer Analgesic Plaster Combined with Acupuncture Three-Step Drug Analgesic Method

目的研究中药外敷抗癌止痛贴联合针刺三阶梯药物止痛法治疗癌症疼痛的临床效果,探讨一种有效疗法,以减轻患者疼痛,提高其身心舒适度。方法选取该院2019年11月—2020年11月的126例癌症疼痛患者,随机纳入A组与B组,每组63例,A组予以吗啡止痛,B组予以中药外敷抗癌止痛贴联合针刺三阶梯药物止痛法治疗,对比两组患者的中医证候积分、疼痛程度(VAS评分)、疼痛介质(5-羟色胺、前列腺素E;、内皮素-1)、炎性因子水平(肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6)、舒适度(GCQ评分)、生活质量(KPS评分)以及不良反应(便秘、腹泻、皮疹疱疹、恶心呕吐)。结果治疗后,B组治疗后的中医证候积分(4.14±0.98)分,A组治疗后的中医证候积分(6.03±1.07)分,B组明显低于A组,两者差异具有统计学意义(P<0.05);治疗后,B组治疗后的VAS评分(1.76±0.87)分,A组治疗后的VAS评分(3.91±1.03)分,B组明显低于A组,两者差异具有统计学意义(P<0.05)。治疗前的两组的5-羟色胺为、前列腺素E2、内皮素-1的水平均无明显差异;B组治疗后的5-羟色胺为(0.36±0.06)ng/L、前列腺素E2为(65.78±15.39)、内皮素-1为(104.73±21.03)ng/L,A组治疗后的5-羟色胺为(0.53±0.08)ng/L、前列腺素E2为(96.25±20.83)ng/L、内皮素-1为(173.92±26.65)ng/L,三者B组均低于A组(P<0.05)。治疗前的两组的肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6的水平均无明显差异;B组治疗后的肿瘤坏死因子-α为(154.93±25.03)ng/L、白细胞介素-1β为(38.03±10.90)ng/L、白细胞介素-6为(123.85±21.43)ng/L,A组治疗后的肿瘤坏死因子-α为(376.14±34.76)ng/L、白细胞介素-1β为(72.67±13.54)ng/L、白细胞介素-6为(165.97±25.76)ng/L,三者B组均低于A组,P<0.05。B组治疗后的肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6均低于A组(P<0.05)。治疗前,两组患者的的GCQ评分、KPS评分无显著差异,B组治疗后的GCQ评分为(82.34±9.87)分、KPS评分为(80.69±9.21),A组治疗后的GCQ评分为(74.24±9.13)分、KPS评分为(57.94±10.63),B组均高于A组(P<0.05)。在不良反应发生情况看,治疗后,B组的不良反应总发生率为16.67%(7/63);A组的不良反应总发生率为19.05%(8/63);两组的不良反应发生率相近(P>0.05)。结论中药外敷抗癌止痛贴联合针刺三阶梯药物止痛法治疗癌症疼痛的临床效果确切,可明显减轻患者疼痛,改善疼痛介质与炎性因子水平,提高患者舒适度与生活质量,且不良反应少,具有一定的安全性,值得推广。

Objective To study the clinical effect of external application of anti-cancer painkiller plaster combined with acupuncture three-step drug analgesia in the treatment of cancer pain and explore an effective treatment to reduce the pain of patients and improve their physical and mental comfort.Methods A total of 126 patients with cancer pain from November 2019 to November 2020 were randomly included in group A and group B,63 patients in each group.The morphine analgesia was used in group A,and anti-cancer pain plaster combined with acupuncture with three-step drug analgesia was used in group B.The TCM syndrome score,pain degree(VAS score),pain mediators(serotonin,prostaglandin E2,endothelin-1),inflammatory factor level(tumor necrosis factor-α、Interleukin-1β、Interleukin-6),comfort(GCQ score),quality of life(KPS score)and adverse reactions(constipation,diarrhea,rash and herpes,nausea and vomiting)were compared.Results After treatment,the TCM syndrome score of group B after treatment was(4.14±0.98)points and that of group A after treatment(6.03±0.87)points.The results showed that the difference was significant between group B and group A(P<0.05).After treatment,VAS score of group B was 1.76 and that of group A was 3.91.The results showed that the difference was significant between group B and group A(P<0.05).There was no significant difference in the levels of 5-hydroxytryptamine,prostaglandin E2 or endothelin-1 between the two groups before treatment.In group B after treatment,5-hydroxytryptamine was(0.36±0.06)ng/L,PGE2 was(65.78±15.39)ng/L,endothelin-1 was(104.73±21.03)ng/L.Those of group A were(0.53±0.08)ng/L,(96.25±20.83)ng/L and(173.92±26.65)ng/L respectively.The results showed that the levels of group B were lower than those of group A(P<0.05).There was no significant difference in the level of IL-6,IL-1βor TNF-αbetween two groups before treatment.After treatment in group B,TNF-αwas(154.93±25.03)ng/L and IL-1βwas(38.03±10.90)ng/L and IL-6 was(123.85±21.43)ng/L and those in group A were(376.14±34.76)ng/L,(72.67±13.54)ng/L and(165.97±25.76)ng/L respectively.Those of group B were significantly lower than those of group A(P<0.05).Before treatment,there was no significant difference in GCQ score or KPS score between the two groups.The GCQ score of group B was 82.34±9.87 after treatment and KPS score was 80.69±9.21.GCQ score of group A was 74.24±9.13 after treatment and KPS score 57.94±10.63.The results showed that the results of the study were higher in group A(P<0.05).In the case of adverse reactions,the incidence of adverse reactions in group B was 7(16.67%).The incidence of adverse reactions in group A was 8(19.05%).The incidence of adverse reactions in the two groups was similar(P>0.05).Conclusion The clinical effect of external application of anti-cancer painkiller plaster combined with acupuncture with three-step drug analgesia is accurate,which can obviously reduce the pain of patients,improve the level of pain medium and inflammatory factors,improve the comfort and quality of life of patients,and have less adverse reactions,which is safe and worthy of implementation.