针刺联合阿片类药物治疗中重度癌性疼痛:随机对照研究

Acupuncture combined with opioid drugs on moderate and severe cancer pain: a randomized controlled trial

目的:探讨针刺联合阿片类药物治疗中重度癌性疼痛的临床疗效。方法:将60例癌症患者随机分为观察组与对照组,各30例。对照组给予盐酸羟考酮缓释片口服;观察组采用盐酸羟考酮缓释片口服联合针刺治疗,针刺选取合谷、内关、足三里、三阴交等穴,再根据原发脏腑和疼痛部位配合相应的背俞穴、郄穴、阿是穴,每日治疗1次,共治疗2周。试验期间两组均予以对症、支持治疗,且未行其他止痛治疗。记录试验期间两组患者每24小时服用阿片类药物的剂量及其不良反应的发生情况,比较两组治疗前后远期生活质量评估(Karnofsky performance status,KPS)量表、生活质量(QOL)量表评分,运用数字疼痛强度量表(numerical rating scale,NRS)评价临床疗效。结果:与治疗前比较,治疗后观察组24 h服用阿片类药物剂量明显减少(P<0.01),对照组明显增加(P<0.05),且观察组明显少于对照组(P<0.01);治疗后两组KPS、QOL量表评分均显著增加(P<0.01),且观察组高于对照组(P<0.01,P<0.05);观察组缓解疼痛的总有效率达到90.0%(27/30),优于对照组的76.7%(23/30,P<0.05);观察组不良反应发生率低于对照组(P<0.01)。结论:针刺联合阿片类药物治疗癌性疼痛可明显减轻癌痛患者的疼痛程度,改善患者的行为状态和生活质量,减少阿片类药物的使用剂量及不良反应的发生率。

Objective To explore the clinical therapeutic effect of acupuncture combined with opioid drugs on moderate and severe cancer pain. Methods A total of 60 patients with cancer were randomized into an observation group and a control group, 30 cases in each group. Oxycodonehydrochloride prolonged-release tablet was taken orally in the control group. On the basis of the control group, acupuncture was applied at Hegu(LI 4), Neiguan(PC 6), Zusanli(ST 36), Sanyinjiao(SP 6), etc. Corresponding back-shu points, xi-cleft points and ashi points were selected additionally according to primary viscera and pain sites in the observation group. The treatment was given once a day for 2 weeks. Symptomatic and supportive treatment were implanted, and no other antalgic measures were given during the trial. The daily dosage of opioid drug and the adverse reactions were recorded in both groups. Karnofsky performance status(KPS) and quality of life(QOL) scale scores were compared before and after treatment. Numerical rating scale(NRS) score was calculated to evaluate the clinical therapeutic effect. Results Compared before treatment, the daily dosage of opioid drugs after treatment was obviously reduced in the observation group(P<0.01), and was obviously increased in the control group(P<0.05). The dosage of opioid drugs after treatment in the observation group was much less than the control group(P<0.01). After treatment, the KPS and QOL scores were increased in both groups(P<0.01), and the scores in the observation group were superior to the control group(P<0.01, P<0.05). The analgesic effective rate was 90.0%(27/30) in the observation group, which was superior to 76.7%(23/30) in the control group(P<0.05). The adverse reactions rate in the observation group was lower than the control group(P<0.01). Conclusion Acupuncture combined with opioid drugs can effectively relieve the cancer pain, improve the performance status and quality of life in cancer patients, reduce the dosage of opioid drugs and adverse reactions rate.