针刺联合三阶梯药物止痛法治疗癌性疼痛40例临床观察

Clinical Observation on Acupuncture Combined with Three-Step Analgesic Therapy in the Treatment of 40 Cases of Cancer Pain

目的探讨针刺联合三阶梯药物止痛法治疗癌性疼痛(癌痛)的临床疗效。方法将病理学确诊的住院癌痛患者80例随机分为治疗组和对照组各40例。两组患者均根据世界卫生组织癌痛三阶梯止痛治疗指南用药,治疗组在此基础上给予针刺阿是穴(在疼痛范围内≤2个穴位)、合谷穴(双侧)、大椎穴、大杼穴(双侧)、阳陵泉穴(双侧)、太冲穴(双侧),每日针刺1次,连续治疗2周。观察两组患者治疗前后疼痛程度评分(NRS)、镇痛起效和缓解持续时间、疼痛缓解情况、首日与全程等效吗啡消耗量及不良反应情况。结果治疗后两组NRS评分均较治疗前下降,且治疗组评分低于对照组(P <0. 05)。治疗组镇痛起效时间短于对照组,镇痛缓解持续时间长于对照组(P <0. 05)。治疗组疼痛缓解总有效率为82. 5%,对照组为57. 5%,两组差异具有统计学意义(P <0. 05)。治疗组治疗全程等效吗啡消耗量低于对照组(P <0. 05)。治疗组出现恶心、呕吐、乏力、便秘及头晕等不良反应的发生率均明显低于对照组(P <0. 05)。结论针刺联合三阶梯药物止痛疗法较单纯三阶梯药物止痛法能提高癌性疼痛的疗效,有较好的镇痛作用,并可减少吗啡用量及降低不良反应发生率。。

Objective To explore the clinical effects of acupuncture combined with three-step analgesic therapy in the treatment of cancer pain. Methods A total of 80 patients with cancer pain diagnosed by pathology were randomly divided into treatment group and control group,with 40 cases in each group. Both groups of patients were treated by the three-step analgesic therapy of World Health Organization according to the severity of pain,and the treatment group was additionally treated with acupuncture at the Ashi acupoint(chosen not more than 2 acupoints near the pain area),Hegu(LI 4)(bilateral),Dazhui(DU 14),Dazhu(BL 11)(bilateral),Yanglingquan(GB 34)(bilateral),Taichong(LV 3)(bilateral). Acupuncture was given once a day for consecutive 2 weeks. The number rating scale(NRS),persistent period of pain alleviation and relief,situation of pain relief,the equivalent of morphine consumption on the first day and the whole course,and adverse reaction of the two groups were observed before and after treatment. Results After treatment,NRS in both groups were lower than those before treatment,and the scores in the treatment group were lower than those in the control group(P < 0. 05). The total effective rate of pain relief was 82. 5% in the treatment group and 57. 5% in the control group,and the difference between both groups was statistically significant(P < 0. 05). The total equivalent morphine consumption in the treatment group was lower than that in the control group(P < 0. 05). After the treatment,the incidence of adverse reactions such as nausea,vomiting,fatigue,constipation and dizziness in the treatment group was significantly lower than that in the control group(P < 0. 05). Conclusion Acupuncture combined with the three-step analgesic therapy to improve cancer pain and relieve pain duration is better than the three-step analgesic therapy alone. Meanwhile,it has good analgesic effect and can reduce the dosage of morphine and the incidence of adverse reactions.