鞘内注射阿片类药物联合自拟中药穴位贴敷对中重度癌性疼痛、睡眠和生活质量的影响

Effects of intrathecal injection of opioids combined with traditional Chinese medicine acupoint application on moderate and severe cancer pain,sleep and quality of life in patients with advanced malignant tumor

目的观察鞘内注射阿片类药物联合自拟中药穴位敷贴对中重度癌性疼痛、睡眠和生活质量的影响,并探讨其作用机制。方法将100例中重度癌性疼痛患者随机分为观察组(50例)和对照组(50例),对照组给予鞘内注射吗啡镇痛(起始量为日平均用量的1/300),观察组在对照组基础上给予自拟中药穴位贴敷治疗,疗程4周。观察2组治疗前后疼痛、睡眠和生活质量情况,检测2组治疗前后血浆钙素基因相关肽(CGRP)、前列腺素E2(PGE2)和β-内啡肽(β-EP)水平。结果 2组治疗第2周、第4周静息状态下和运动状态下的视觉模拟疼痛评分(VAS)、爆发性疼痛频率、日均吗啡平均用量均显著降低(P均<0.05),且观察组的改善情况显著优于对照组(P均<0.05);观察组中度疼痛、重度疼痛患者疼痛缓解有效率均显著高于对照组(P均<0.05);2组治疗第2周、第4周匹兹堡睡眠质量指数问卷(PSQI)评分及血浆CGRP、PGE2、β-EP水平均明显低于治疗前(P均<0.05),患者生活质量量表(QLQC30)评分均显著高于治疗前(P均<0.05),且观察组上述指标改善情况均显著优于对照组(P均<0.05)。观察组治疗第2周、第4周的不良反应发生率均显著低于对照组(P均<0.05)。结论鞘内注射吗啡联合自拟中药穴位贴敷能够显著缓解中重度癌性疼痛,减少吗啡用量,提高患者睡眠质量及生活质量,且能够减少不良反应,机制可能与下调血浆CGRP、PGE_2及β‐EP水平有关。

Objective It is to observe the influence of intrathecal injection of opioids combined with acupoint application of traditional Chinese medicine on moderate and severe cancer pain,sleep and quality of life in patients with advanced malignant tumor,and discuss its mechanism. Methods One hundred patients with moderate or severe cancer pain were randomly divided into observation group（ 50 cases） and control group（ 50 cases）. The control group were received intrathecal injection of morphine for analgesia（ the initial dose was 1/300 of daily average dosage）. The observation group was treated with acupoint application on the basis of the control group. The course of treatment was 4 weeks. The pain,sleep and quality of life of the two groups before and after treatment were observed,and the levels of plasma calcitonin gene related peptide（ CGRP）,prostaglandin E-2（ PGE2） and β endorphin（ β-EP） were detected before and after treatment in the two groups. Results The visual analogue pain score（ VAS）,the frequency of explosive pain and the average daily dose of morphine under resting state and exercise state in the 2 groups were significantly decreased（ all P〈 0. 05） in the second and the fourth week,and the improvement of the observation group was significantly better than that of the control group（ P〈 0. 05）. The effective rate of pain relief in the observation group was significantly higher than that in the control group（ P〈 0. 05）. The scores of Pittsburgh sleep quality index（ PSQI）,and the levels of plasma CGRP,PGE2 and β-EP in the two groups were significantly lower,but the quality of life scale（ QLQ-C30） scores were significantly higher than those before treatment（ all P〈 0. 05） in the second and the fourth week,and the improvement of the above indexes in the observation group was significantly better than that in the control group（ P〈 0. 05）. The incidences of adverse reactions in the observation group were significantly lower than those in the control group（ all P〈 0. 05） in the second and the fourth week. Conclusion Intrathecal injection of morphine combined with acupoint application of traditional Chinese medicine can significantly relieve moderate and severe cancer pain,reduce the amount of morphine,improve the quality of sleep and the quality of life in patients,and it can reduce the adverse reaction,the mechanism may be related to the downregulation of plasma CGRP,PGE2 and β-EP levels.