热敏灸联合西药治疗正虚瘀结型结肠癌重度癌痛的疗效及作用机制探究

Curative Effect and Mechanism of Heat-sensitive Moxibustion Combined with Western Medicine in Treating Severe Colon Cancer Pain of Deficient Healthy Qi and Blood Stasis Type

目的:探讨热敏灸联合西药治疗正虚瘀结型结肠癌重度癌痛的临床疗效及可能作用机制。方法:将60例正虚瘀结型结肠癌患者按随机数字表法分为对照组和观察组各30例。对照组予硫酸吗啡缓释片治疗,观察组在此基础上予热敏灸治疗,治疗2周。于治疗前后,评定癌痛数字分级法(NRS)评分、卡氏功能状态(KPS)评分,记录24 h内疼痛总时间、睡眠时间及爆发痛次数,测定血清环氧合酶-2(COX-2)及内皮素-1(ET-1)水平,并于治疗结束后进行疗效评定。结果:治疗后,观察组的有效率明显高于对照组(P<0.05);观察组NRS评分较治疗前明显降低(P<0.05),且低于对照组(P<0.05);观察组24 h疼痛时间、睡眠时间及爆发痛次数均较治疗前改善(P<0.05),且均明显优于对照组(P<0.05);观察组KPS评分明显升高(P<0.05),且高于对照组(P<0.05);观察组血清COX-2、ET-1水平明显降低(P<0.05),且低于对照组(P<0.05)。结论:热敏灸联合西药治疗正虚瘀结型结肠癌重度癌痛疗效确切,可减轻患者疼痛程度,减少疼痛时间及爆发痛次数,改善睡眠,提高患者生存质量,这可能与其降低血清COX-2、ET-1水平有关。

Objective:To observe the curative effect and mechanism of heat-sensitive moxibustion combined with western medicine in treating severe colon cancer pain of deficient healthy qi and blood stasis type.Methods:Total 60 patients with colon cancer of deficient healthy qi and blood stasis type were randomly divided into the control group(30 patients)and the observation group(30 patients)according to the random number table method.The control group was given morphine sulfate sustained-release tablets.The observation group was given heat-sensitive moxibustion based on western medicine treatment.Both groups were treated for 2 weeks.Before and after treatment,Numerical rating scale(NRS)score and Karnofsky performance status(KPS)score were assessed,and the total pain duration,sleep duration and pain outbreak frequency within 24 hours were recorded.The serum levels of cyclooxygenase-2(COX-2)and endothelin-1(ET-1)were measured.The curative effect was evaluated after treatment.Results:The effective rate of the observation group was higher than that of the control group(P<0.05).After treatment,NRS score in the observation group was significantly lower than that before treatment(P<0.05),and lower than that in the control group(P<0.05).The 24-hour pain duration,sleep duration and pain outbreak frequency in the observation group were all improved compared with those before treatment(P<0.05),and were significantly better than those in the control group(P<0.05).KPS score of the observation group was significantly increased(P<0.05)and higher than that of the control group(P<0.05).The serum levels of COX-2 and ET-1 in the observation group were significantly decreased(P<0.05)and lower than those in the control group(P<0.05).Conclusions:Heat-sensitive moxibustion combined with western medicine has a definite effect on treating severe colon cancer pain of deficient healthy qi and blood stasis type,which can relieve the pain degree,reduce the pain duration and pain outbreak frequency,improve sleep and the life quality of patients.This may be related to the reduction of serum levels of COX-2 and ET-1.