针刺补肾祛瘀法治疗中重度骨转移癌痛的临床研究

Clinical research in the treatment of moderate and severe bone metastasis pain with acupuncture for tonifying kidney and eliminating stasis

目的评价针刺补肾祛瘀法治疗骨转移疼痛的临床疗效。方法采用前瞻性的随机对照方法,将60例患者随机分为针刺组(30例)和西药组(30例),针刺组予针刺加奥施康定(盐酸羟考酮控释片)止痛,西药组予奥施康定止痛治疗,疗程7 d,观察疼痛数字评分(NRS)、体力状况评分(卡氏评分,KPS)、奥施康定使用量、呕吐、便秘次数等指标的变化情况。结果与本组治疗前比较,两组病例治疗后NRS评分降低、KPS升高,差异有统计学意义。与西药组比较,针刺组治疗后NRS评分明显降低,差异有统计学意义,而治疗后两组KPS评分比较差异无统计学意义。针刺组治疗前后爆发痛次数、呕吐次数和便秘次数比较差异有统计学意义,而西药组治疗前后爆发痛次数、呕吐次数和便秘次数比较差异无统计学意义;两组病例治疗后爆发痛次数比较差异有统计学意义,而呕吐次数和便秘次数比较差异无统计学意义。针刺组治疗前后奥施康定剂量比较差异有统计学意义(P<0.05),而西药组治疗前后奥施康定剂量比较差异无统计学意义(P>0.05);两组病例治疗后奥施康定剂量比较差异有统计学意义(P<0.05)。两组病例资料后疼痛缓解率比较差异有统计学意义(χ2=6.787,P=0.009)。结论针刺补肾化瘀法联合奥施康定更能有效缓解骨转移疼痛,而且针刺疗法可有效缓解奥施康定呕吐、便秘等副作用,有效改善了患者的生活质量。

Objective To evaluate the clinical therapeutic effects on moderate and severe bone metastasis pain with acupuncture for tonifying kidney and eliminating stasis. Methods The prospective randomized controlled method was adopted. 60 patients were randomized into an acupuncture group（30 cases） and a western medicine group（30 cases）. In the acupuncture group,acupuncture was used in combination with oxycontin（oxycodone hydrochloride controlled-release tablets） for analgesia. In the western medicine group,oxycontin was used for analgesia. The duration of treatment was 7 days. NRS,KPS,the dose of oxycontin and the frequency of vomiting and constipation were observed before and after treatment. Results After treatment,in the acupuncture group,NRS score,the frequency of breakthrough pain and the dose of oxycontin were all reduced significantly（P〈0. 05）,KPS was increased significantly and the frequency of vomiting and constipation was reduced remarkably（P〈0. 05）. In the western medicine group,NRS score was reduced significantly and KPS score was increased significantly（P〈0. 05）. The frequency of breakthrough pain,the dose ofoxycontin and frequency of vomiting and constipation did not change remarkably（P〈0. 05）. After treatment,in comparison of the two groups,the differences were significant in NRS score,the frequency of breakthrough pain,the dose of oxycontin and the frequency of vomiting and constipation,as well as the total effects（P〈0. 05）. Conclusion In the treatment of moderate and severe bone metastasis pain,the acupuncture therapy for tonifying kidney and eliminating stasis achieves the much more effects combined with oxycontin. The acupuncture therapy effectively relieves the side effects of oxycontin,such as vomiting and constipation,and improves the living quality of the patients.