中药外用治疗癌性疼痛患者阿片类药物相关性便秘述评

Traditional Chinese Medicine External Therapy Treatment of Opioid Drug-Related Constipation in Patients with Cancer Pain

中药外治法治疗癌性疼痛患者阿片类药物相关性便秘有较好的临床疗效,且具有以下优势:(1)可绕过肝脏首过效应,避免胃肠因素的干扰和灭活;(2)可缩小个体间及个体内各次用药之间的差异;(3)维持较稳定的血药浓度;(4)可延长药物作用时间,减少给药次数和总剂量;(5)不良反应少,用药量少,操作简便,患者易接受;(6)可起到穴位刺激和药物局部吸收的双重作用,为不能口服用药的患者提供治疗途径。中药外治法治疗癌性疼痛患者阿片类药物相关性便秘所选用的贴敷药物多以大黄为主药,或以行气药为主,或配以养阴润燥方药;穴位贴敷以腹部任脉及足阳明胃经穴位为多,如神阙、天枢、气海、关元、足三里等;灌肠药以承气汤加减和增液承气汤加减应用较多,且在灌肠药物的温度、速度方面,多主张缓慢、寒温适宜。中药外治法治疗癌性疼痛患者阿片类药物相关性便秘有着局部辨病论治的优势,但临床应用时应从整体角度出发,依据患者病情结合其他疗法,以取长补短。

Traditional Chinese medicine external therapy treatment of patients with cancer pain patients with opioid drug-related constipation has a better clinical efficacy,and has the following advantages：（1）It can avoid the interference and inactivation of gastrointestinal factors by bypassing the first pass effect of liver;（2） it can reduce the difference of drug use among individuals and within individuals;（3）maintaining stable blood concentration;（4）it can prolong the time of drug action,reduce the times of administration and the total dose;（5）less adverse reactions,less dosage,easy to operate,and easy to accept by the patients;（6）it can play a dual role of acupoint stimulation and local absorption of drugs,which provides a therapeutic approach for patients who cannot be treated orally. Traditional Chinese medicine external therapy treatment for patients with cancerous pain patients with opioid drugrelated constipation of the application of drugs used to use rhubarb as the main drug,or mainly Qi-activating drug,or combined with nourishing Yin to moisten dryness medicine. Acupoints applied to the abdominal Ren channel and foot Yangming stomach meridian acupoints for many,such as Shenque（ RN8）,Tianshu（ ST25）,Qihai（ RN6）,Guanyuan（ RN4）,Zusanli（ ST36）,etc. For enema,Chengqi decoction and Zengye Chengqi decoction are used more frequently,and the temperature and speed of enema medicine are slow and cold temperature is suitable. Traditional Chinese medicine external therapy treatment of patients with cancer pain patients with opioid drug-related constipation has the advantage of local differentiation,but the clinical application should be based on the whole point of view and combined with other therapies according to the patients＇ condition.