针灸辅助三级阶梯止痛治疗癌性疼痛效果及对生活质量的影响

Effect of acupuncture-assisted three-step analgesia on cancer pain analgesia and quality of life

目的观察针灸辅助三级阶梯止痛治疗癌性疼痛的效果及对患者生活质量的影响。方法将2016年5月—2018年10月上海中医药大学附属市中医医院和上海市第八人民医院收治的100例癌性疼痛患者随机分为2组,对照组50例给予阶梯止痛疗法治疗,观察组50例在对照组治疗基础上加用针灸治疗,连续治疗7 d,比较2组治疗后临床总有效率、疼痛缓解时间及数字疼痛强度量表(NRS)评分、生活质量(生理功能、心理功能、社会功能、生活环境、总体感觉),检测2组治疗前后血清疼痛介质[五羟色胺(5-HT)、内皮素-1(ET-1)、前列腺素E 2(PGE 2)]变化情况,统计2组不良反应发生情况。结果观察组总有效率为92%(46/50),显著高于对照组的78%(39/50),差异有统计学意义(P<0.05);2组治疗后NRS评分均较治疗前降低(P均<0.05),且观察组降低更明显(P<0.05);观察组治疗后疼痛缓解时间明显短于对照组(P<0.05);2组治疗后生理功能、心理功能、社会功能、生活环境及总体感觉评分均较治疗前升高(P均<0.05),且观察组与对照组比较升高程度更明显(P均<0.05);2组治疗后5-HT、ET-1和PGE 2水平均较治疗前降低(P均<0.05),且观察组较对照组降低程度更明显(P均<0.05);2组治疗前后血压、心率、血常规、心电图、肝肾功能均无明显变化,观察组不良反应发生率为6%(3/50),明显低于对照组的24%(12/50),差异有统计学意义(P<0.05)。结论针灸辅助阶梯止痛疗法能够有效抑制癌性疼痛患者体内致痛物质表达,提高镇痛效果,缓解患者疼痛,改善患者生活质量,且能够明显减轻西药产生的不良反应。

Objective It is to observe the effects of acupuncture-assisted three-step analgesia on cancer pain analgesia and quality of life.Methods One hundred patients with cancer pain treated in Shanghai Affiliated Hospital of Traditional Chinese Medicine of Shanghai University of Traditional Chinese Medicine and Shanghai Eighth People’s Hospital from May 2015 to October 2018 were randomly divided into 2 groups.50 patients in the control group were treated with step analgesia,50 cases in the observation group were treated with acupuncture on the basis of the treatment of the control group,both groups were continuously treated for 7 days.The total clinical effective rate,pain relief time,and the improvement of NRS score and quality of life(physiological function,psychological function,social function,living environment,overall feeling),pain mediators[serotonin(5-HT),endothelin-1(ET-1),prostaglandin E 2(PGE 2)]were compared between the two groups,the occurrence of adverse reactions in the 2 groups was counted.Results The total effective rate of the observation group was 92%(46/50),which was significantly higher than that 78%(39/50)in the control group(P<0.05).After treatment,the NSE scores of the two groups were significantly decreased(P<0.05),and the decrease of NSE score of the observation group was more significant that that of the control group(P<0.05).The pain relief time of the observation group was significantly shorter than that of the control group(P<0.05).The scores of physical function,mental function,social function,living environment and overall feeling of the two groups after treatment were all higher while the levels of 5-HT,ET-1 and PGE 2 were lower than those before treatment(P<0.05),and the increase or decrease of these indexes in the observation group were more significant than those of the control group(P<0.05).There was no significant changes in blood pressure,heart rate,blood routine,electrocardiogram,liver and kidney function in the two groups before and after treatment,and the incidence of adverse reactions in the observation group was 6%(3/50),which was significantly lower than 24%(12/50)of the control group(P<0.05).Conclusion Acupuncture-assisted step analgesia therapy can effectively inhibit the expression of pain-causing substances in patients with cancer pain,improve the analgesic effect,relieve the pain and improve the quality of life of patients,and can significantly reduce the adverse reactions caused by western medicine.