吗啡控释片与芬太尼透皮贴联合盐酸羟考酮缓释片治疗中重度癌痛的疗效观察

Efficacy of controlled-release morphine tablets and fentanyl transdermal patch combined with hydrochloride oxycodone sustained-release tablets for moderate to severe cancer pain

目的探讨吗啡控释片与芬太尼透皮贴联合盐酸羟考酮缓释片治疗中重度癌痛的临床疗效。方法选取2018年10月至2020年3月间上海市金山区金山卫镇社区卫生服务中心收治的120例中重度肿瘤患者,采用简单随机分层法分为观察组和对照组,每组60例。对照组患者采用吗啡控释片与芬太尼透皮贴治疗,观察组患者在对照组基础上联合使用盐酸羟考酮缓释片治疗,比较两组患者β-内啡肽(β-EP)、5-羟色胺(5-HT)、负性情绪和不良反应。结果治疗后,两组患者血清β-EP与5-HT水平均优于治疗前,且观察组均优于对照组,差异均有统计学意义(均P<0.05)。治疗后,两组患者NRS均优于治疗前,且观察组优于对照组,差异均有统计学意义(均P<0.05)。观察组患者总有效率为91.7%,优于对照组的76.7%,差异有统计学意义(P<0.05)。但两组患者整体效率比较,差异无统计学意义(P>0.05)。治疗后,两组患者抑郁自评量表和汉密顿抑郁量表评分均优于治疗前,且观察组均优于对照组,差异均有统计学意义(均P<0.05)。两组患者眩晕、恶心呕吐、镇静与瘙痒发生率比较,差异无统计学意义(P>0.05);观察组患者便秘发生率高于对照组,差异有统计学意义(P<0.05)。结论吗啡控释片与芬太尼透皮贴联合盐酸羟考酮缓释片可有效改善中重度肿瘤患者血清β-EP和5-HT水平,降低患者疼痛,改善负性情绪,但会增加便秘发生率。

Objective To explore the efficacy of controlled-release morphine tablets and fentanyl transdermal patch combined with hydrochloride oxycodone sustained-release tablets for moderate to severe cancer pain.Methods A total of 120 patients with moderate to severe cancer admitted to Jinshanwei Town Community Health Service Center from October 2018 to March 2020 were selected.They were divided into an observation group and a control group using a simple random stratification method.The observation group received controlled-release morphine tablets and fentanyl transdermal patch combined with hydrochloride oxycodone sustained-release tablets and the control group received controlled-release morphine tablets and fentanyl transdermal patch.The serum β-endorphin(β-EP),5-hydroxytryptamine(5-HT),negative mood and adverse reactions were compared between the two groups.Results After the treatment,the serum β-EP and 5-HT levels were improved in both groups with those better in the observation group than in the control group(all P<0.05).The numerical rating scale(NRS)scores were improved in both groups after the treatment compared with before the treatment and NRS scores were better in the observation group than in the control group(all P<0.05).The overall efficacy rate was 97.1%in the observation group,which was better than 76.67%of the control group(P<0.05).In general,there was no significant difference in the overall efficacy between the two groups(P>0.05).After the treatment,self-rating depression scale(SDS)and Hamilton depression rating scale(HDRS)were better than those before the treatment with the observation group better than the control group(all P<0.05).There was no significant deference in the incidence of dryness,nausea and vomiting,sedation and itching between the two groups(P>0.05).The incidence of constipation was higher in the observation group than in the control group(P<0.05).Conclusion Controlled-release morphine tablets and fentanyl transdermal patch combined with hydrochloride oxycodone sustained-release tablets can effectively improve serum β-EP and 5-HT levels,reduce pain,and improve negative emotions in patients with moderate to severe cancer.However,this treatment will increase the incidence of constipation.