阿片类联合激素及抗惊厥药治疗晚期癌痛的临床观察

Obseration of opioid combined with corticosteroids or anticonvulsants for advanced cancer patients with pain

目的探讨晚期癌痛应用阿片类药物的合理用药方案。方法选择伴有中、重度疼痛的晚期肿瘤患者,分3组,第一组36例,采用盐酸羟考酮控释片(奥施康定)单药治疗;第二组19例,用奥施康定和甲强龙联合治疗;第三组25例,用奥施康定联合加巴喷丁。观察3组患者治疗后的疼痛缓解情况和生活质量。结果单用奥施康定组完全缓解率为63.9%,奥施康定联合甲强龙组为68.4%,奥施康定和加巴喷丁联用组为48.0%。主要毒副反应为便秘,其次为恶心、呕吐。第二组毒副反应最轻,第三组部分患者出现头晕和嗜睡。结论阿片类药物奥施康定治疗晚期癌痛具有较好的疗效,其中奥施康定联合甲强龙尤其适合肺癌伴脑转移或骨转移患者,且安全性高,值得临床推广。

Objective The study was to explore rational administration of antalgesic drugs for relieving pain, reducing sideeffects and ameliorating the quality of life （QOL） in patients with advanced cancer. Methods Patients with moderate and severe pain were selected and classified into three groups： administrating oxycodone hydrochloride controlled-release tablets （oxycodone） , oxycodo- ne plus methylprednisolone, oxycodone plus gabapentin, respectively. Pain remission and the quality of life（QOL） in patients were re- corded and compared. Results The rates of complete remission（CR） were 63.9% , 68.4% and 48.0% for the three groups. The ma- jor side-effects were constipation, followed by nausea or vomiting. The second group presented the weakest side-effects, and a minority of patients in the third group appeared somnolence symptoms. Conclusion Opioid drug oxycodone has well efficacy and safety in the treatment of advanced patients with cancer pain, and oxycodone plus methylprednisolone may be the optimal administration of antalgesic drugs for some of the patients with advanced tumors, especially for the lung cancer with brain metastasis and bone metastasis.