盐酸吗啡缓释片联合枳术汤合补中益气汤加味治疗癌性疼痛的临床观察

Slow-release morphine and Chinese medicine Zhishu Decoction plus Buzhongyiqi Decoction for terminal cancerous pain

目的观察盐酸吗啡缓释片联合中药方剂枳术汤合补中益气汤加味治疗晚期癌性疼痛。方法2006年7月至2008年7月共观察221例晚期癌症疼痛患者,将这些患者按入院次序分为两组:实验组111例服用盐酸吗啡缓释片加常规对症治疗,同时服用中医汤剂枳术汤联合补中益气汤加味,中药使用每天1剂,连服1～2周;以后隔天服用1次,连续服用1个月。对照组110例服用盐酸吗啡缓释片与常规对症治疗。观察患者的止痛效果,生存质量改善状况,便秘、恶心、呕吐等吗啡不良反应的发生状况。结果两组患者的疼痛均明显减少,减低程度两组间差异无统计学意义(P>0.05)。实验组与对照组生活质量改善状况分别为60.9%与42.7%(P<0.05),其中食欲的改善为55.9%与23.4%(P<0.05);出现便秘的概率分别为83.6%与32.4%(P<0.01);恶心、呕吐的概率分别为50.0%与27.1%(P<0.01)。结论盐酸吗啡缓释片联合枳术汤合补中益气汤加味是治疗晚期癌性疼痛的有效方法。

Objective To evaluate the therapeutic efficacy of sustained-release morphine combined with traditional Chinese medicine Zhishu Decoction plus Buzhongyiqi Decoction for the patients with terminal cancerous pain. Methods Two hundred and twenty-one patients with terminal cancerous pain were divided into two groups from July 2006 to July 2008 according to admission order. In spite of sustained-release morphine and allopathy, 111 patients in the test group were treated by conventional Chinese medicine,Zhishu Decoction plus Buzhongyiqi Decoction,which were given one dose every day for 1 or 2 weeks; then these Chinese medicines were given every other day for a month. 110 patients in the control group were only treated by sustained-release morphine and allopathy. Then the analgesia effects,quality of life and appetitive and adverse reactions of sustained-release morphine,such as constipation,nausea and vomiting,were observed in the both groups after treatment. Results The cancerous pain degree was obviously lowered in all patients. There were no significant difference in the decrease degree in both groups（P〉0.05）. The improvement for quality of life and appetite was 60.9%vs 42.7% and 55.9% vs 23.4% in the test group vs the control group respectively（P〈0.05）. Constipation, nausea and vomiting, which were the main side-effects of sustained release morphine, were 83.6% vs 32.4 %, 50.0% vs 27.1 %in the test group vs the control group respectively. There was significant difference in the two groups（P〈0.01）. Conclusion Combination of sustained release morphine and Chinese medicine Zhishu Decoction plus Buzhongyiqi Decoction is a better therapeutic method for the patients with terminal cancerous pain.