不同剂量高乌甲素联合硫酸吗啡缓释片治疗老年中重度癌痛的临床观察

Clinical observation of different doses of lappaconitine combined with morphine sulfate sustainedrelease tablets for the treatment of elderly patients with moderate to severe cancer pain

目的观察不同剂量高乌甲素联合硫酸吗啡缓释片治疗老年中重度癌痛的有效性和安全性。方法 90例老年癌痛病人,按随机数字表法均分为对照组(C组)、低剂量组(L组)、高剂量组(H组),3组均以口服硫酸吗啡缓释片为基础治疗,在此基础上C组每天静滴生理盐水100 ml,L组静滴高乌甲素8 mg,H组静滴高乌甲素16 mg,疗程为14 d。记录并比较3组疼痛缓解、生活质量改善及药物不良反应情况。结果 C组与L组、L组与H组疼痛缓解疗效差异无统计学意义(P>0.05)。H组疼痛疗效优于C组差异有统计学意义(P<0.05)。C组即释吗啡片总用量明显多于L组、H组,L组明显多于H组,差异均有统计学意义(P均<0.05)。3组治疗后生活质量评价均优于治疗前;L组、H组一般状况、日常活动、情绪、睡眠、行走能力优于C组,H组情绪和睡眠优于L组(P<0.05),但2组间其他项目比较差异无统计学意义;3组在社交、娱乐项目比较差异无统计学意义。C组头晕、嗜睡、恶心呕吐、便秘、尿潴留发生率明显多于L组、H组,L组恶心呕吐、便秘发生率高于H组,差异均有统计学意义(P<0.05)。结论不同剂量高乌甲素联合硫酸吗啡缓释片治疗老年中重度癌痛均能增加镇痛效果,降低吗啡用量,减少药物不良反应,提高机体免疫力,改善生活质量,但16 mg高乌甲素效果更好,药物不良反应更少。

Objective To observe the effect and safety of different doses of lappaconitine combined with morphine sulfate sustained-release tablets for the treatment of moderate to severe cancer pain in the elderly patients. Methods Ninety cases of elderly patients with cancer pain were selected,and a random number table method was used to divide the 90 patients into control group（ group C）,low dose group（ group L）,and high dose group（ group H）. All three groups took oral morphine sulfate sustained-release tablets for the basic treatment. On the basis of basic treatment,group C was intravenously dripped with normal saline 100 ml per day; group L was intravenously dripped with lappaconitine 8 mg per day; group H was intravenously dripped with lappaconitine 16 mg per day. The entire period of treatment lasted for 14 days. The degree of pain relief,quality of life and adverse drug reactions were recorded and compared.Results The efficacy in pain release showed no significant difference between group C and group L,or between group H and group L（ P〉0. 05）,while showing significant difference between group H and group C（ P〈0. 05）. Total amount of immediate-release morphine tablets in group C was higher than that in groups L,and that in group L was higher than that in group H（ P〈0. 05）. The quality of life was better than that before treatment in the three groups. The general status,daily activity,motions,sleep,and walking ability of group H and group L were better than those of group C. Motions and sleep in group H were significantly better than those of group L（ P〈0. 05）. There was no significant difference between the three groups in social life and entertainment. The incidence rate of dizziness, hypersomnia, nausea, vomiting,constipation,and uroschesis in group C was higher than that in groups H and group L,and the incidence rate of nausea,vomiting and constipation in group L was significantly higher than that in group H（ P〈0. 05）. Conclusions Different doses of lappaconitine combined with morphine sulfate sustained-release tablets in the treatment of elderly patients with moderate to severe cancer pain patients can improve the effect of pain relief,reduce the dosage of morphine,reduce the adverse drug reactions,enhance immunity and improve the quality of life,and the dose of 16 mg per day has the best effect with less adverse reaction.