姑息性放疗联合三阶梯止痛原则治疗非小细胞肺癌骨转移疼痛临床分析

Clinical analysis of palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain in non-small cell lung cancer

目的探讨姑息性放疗联合三阶梯止痛原则治疗非小细胞肺癌(NSCLC)骨转移疼痛的止痛效果、患者生命质量及不良反应发生情况。方法回顾性分析2015年4月至2018年4月福建省立医院收治的88例NSCLC骨转移疼痛患者的临床资料,依据治疗方法分为联合组和对照组,每组44例。联合组采用姑息性放疗联合三阶梯止痛原则治疗,对照组采用三阶梯止痛原则治疗,比较两组患者的止痛疗效、生命质量变化和不良反应。结果联合组总体止痛有效率为84.1%(37/44),高于对照组的54.5%(24/44),两组差异有统计学意义(Z=-3.227,P=0.001)。对于轻、中度疼痛,联合组与对照组的止痛有效率分别为84.6%(11/13)比57.1%(8/14)、80.0%(12/15)比42.9%(6/14),差异均无统计学意义(Z=-1.473,P=0.141;Z=-1.793,P=0.073);对于重度疼痛,联合组与对照组的止痛有效率分别为87.5%(14/16)和62.5%(10/16),差异有统计学意义(Z=-2.327,P=0.020)。联合组的生命质量优于对照组,两组差异有统计学意义(Z=-2.254,P=0.024)。联合组总体不良反应发生率为36.4%(16/44),低于对照组的59.1%(26/44),两组差异有统计学意义(χ2=4.55,P=0.033)。结论姑息性放疗联合三阶梯止痛原则治疗NSCLC骨转移疼痛能够提高止痛疗效,尤其对于重度疼痛患者,能够明显改善患者的生命质量,降低不良反应的发生率。

Objective To investigate the analgesic efficacy, quality of life, and the incidence of adverse reactions of palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain in non-small cell lung cancer(NSCLC). Methods A total of 88 NSCLC patients with metastatic bone pain at Fujian Provincial Hospital from April 2015 to April 2018 were retrospectively analyzed. According to the treatment, the patients were divided into the combined group and the control group, and 44 cases in each group. The combined group was given palliative radiotherapy combined with the principle of three-step analgesic ladder, and the control group received the principle of three-step analgesic ladder. The analgesic efficacy, changes of quality of life, and the incidence of adverse reactions were compared between the two groups. Results The total analgesic effective rate in the combined group was higher than that in the control group [84.1% (37/44) vs. 54.5% (24/44)], and the difference between the two groups was statistically significant (Z=-3.227, P = 0.001). For mild and moderate pain, the effective rate in the combined group and control group were 84.6% (11/13) vs. 57.1% (8/14), 80.0% (12/15)vs. 42.9% (6/14) respectively, and the differences were not statistically significant (Z=-1.473, P = 0.141;Z=-1.793, P = 0.073). For severe pain, the effective rates in the combined group and control group were 87.5% (14/16) and 62.5% (10/16), and the difference was statistically significant (Z=-2.327, P = 0.020). The quality of life in the combined group was better than that in the control group, and the difference between the two groups was statistically significant (Z=-2.254, P =0.024). The overall incidence rate of adverse reactions in the combined group was 36.4% (16/44), which was significantly lower than that in the control group [59.1% (26/44)], and the difference between the two groups was statistically significant (χ 2 = 4.55, P = 0.033). Conclusion Palliative radiotherapy combined with the principle of three-step analgesic ladder in treatment of metastatic bone pain of NSCLC can significantly improve the efficacy, especially for severe pain, and improve the quality of life, and reduce the incidence of adverse reactions.