度洛西汀联合羟考酮缓释片、唑来膦酸治疗骨转移中重度神经病理性癌痛的疗效观察

Curative effect of oxycodone sustained-release tablets and zoledronic acid combined with duloxetine in treatment of moderate to severe malignant neuropathic pain from bone metastasis

目的观察羟考酮缓释片、唑来膦酸联合两类不同的辅助镇痛药对骨转移中重度神经病理性癌痛(MNP)患者的疗效和安全性。方法将117例骨转移癌合并中重度MNP的患者按双盲、随机数字表法分为A组(羟考酮+唑来膦酸)、B组(度洛西汀+羟考酮+唑来膦酸)、C组(普瑞巴林+羟考酮+唑来膦酸),每组39例。比较3组患者治疗前后的数字评分法(NRS)评分、汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、羟考酮人均日剂量、爆发痛人均日发作次数、生活质量(QOL)评分、不良反应发生情况。结果治疗后1个月B组和C组羟考酮人均日剂量均低于A组,爆发痛人均日发作次数均少于A组,QOL评分均高于A组(P﹤0.05),B组和C组比较,差异均无统计学意义(P﹥0.05)。3组患者的NRS、HAMD和HAMA评分在治疗后均随时间逐渐下降(P﹤0.05);治疗后1周、2周、1个月时A组患者NRS评分均高于B组和C组,C组患者NRS评分高于B组,差异均有统计学意义(P﹤0.05),B组和C组患者HAMD和HAMA评分比较,差异均无统计学意义(P﹥0.05)。治疗后1个月3组患者各不良反应发生情况比较,差异均无统计学意义(P﹥0.05)。结论羟考酮缓释片、唑来膦酸联用度洛西汀比联用普瑞巴林能更有效地降低骨转移中重度MNP患者的疼痛评分,并能有效减少爆发痛次数、羟考酮用量,改善抑郁、焦虑、生活质量,安全性较好。

Objective To observe efficacy and safety of oxycodone sustained-release tablets and zoledronic acid combined with duloxetine in treatment of moderate to severe malignant neuropathic pain(MNP)from bone metastasis.Method A total of 117 patients with bone metastasis and moderate to severe MNP were randomly divided into three groups:group A(oxycodone sustained-release tablets+zoledronic acid),group B(oxycodone sustained-release tablets+zoledronic acid+duloxetine)and group C(oxycodone sustained-release tablets+zoledronic acid+pregabalin)double-blindly and randomly,with 39 cases in each group.Numeric rating scale(NRS)score,Hamilton depression scale(HAMD)score,Hamilton anxiety scale(HAMA)score,per capita daily dose of oxycodone,per capita daily attack times of fulminant pain,quality of life(QOL)score and incidence of adverse reactions were compared among the three groups before and after treatment.Result After treatment of one month,the average daily dose of oxycodone in group B and group C was lower than that in group A,the average daily frequency of outbreak pain was less than that in group A,and the QOL score was higher than that in group A(P<0.05).There was no significant difference between group B and group C(P>0.05).The NRS,HAMD and HAMA scores of the three groups decreased gradually with time after treatment(P<0.05).The NRS score of group A was higher than that of group B and group C at 1 week,2 weeks and 1 month after treatment,the NRS score of group C was higher than that of group B,the differences were statistically significant(P<0.05),and the HAMD and HAMA scores of group B and group C were not statistically significant(P>0.05).One month after treatment,there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Oxycodone sustained-release tablets and zoledronic acid combined with duloxetine can more effectively reduce the pain score of moderate to severe MNP patients with bone metastasis than combined with pregabalin,and can effectively reduce number of pain episodes and amount of oxycodone,improve depression,anxiety and quality of life,and has a good safety.