盐酸羟考酮缓释片联合度洛西汀治疗中重度癌痛的临床观察

Assessment of oxycodone hydrochloride combined with duloxetine in treatment of moderate and severe cancer pain

目的探讨盐酸羟考酮缓释片(商品名:奥施康定)联合度洛西汀治疗中重度癌痛的临床疗效。方法选择中重度癌痛患者60例,按入组顺序采用随机数字表法分为奥施康定组(对照组)与奥施康定联合度洛西汀组(联合组)。对照组以前用过强阿片类药物的患者根据用药情况进行剂量转换使用奥施康定,逐渐增量,直至疼痛缓解,视觉模拟评分(visual analogue scale,VAS)<3分或爆发痛<3次;联合组在使用奥施康定(与对照组同)的基础上加用度洛西汀,每天用量60 mg。观察治疗前以及治疗后1、2、3和4周的VAS评分、生活质量(quality of life,QOL)评分、疼痛缓解程度、汉米尔顿抑郁量表-17项(Hamilton depression scale-17,HAMD-17)和汉米尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分、药物的使用量及不良反应。结果治疗后对照组与联合组VAS评分均下降(均P<0.05),联合组下降程度高于对照组(均P<0.05)。两组QOL较治疗前均有改善(均P<0.05),联合组增加程度高于对照组(均P<0.05)。联合组和对照组疼痛缓解总有效率分别为96.7%和73.3%(P<0.05)。对照组与联合组HAMD-17和HAMA评分均有下降,联合组较对照组明显降低(均P<0.05)。联合组阿片类药物使用量较对照组减少(均P<0.05)。两组药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论奥施康定联合度洛西汀治疗中重度癌痛临床疗效显著,安全性高。

Objective To investigate the clinical efficacy of oxycodone hydrochloride sustained-release tablets(trade name:OxyContin)combined with duloxetine in the treatment of moderate and severe cancer pain.Methods Sixty patients with moderate and severe cancer pain were randomly assigned into the OxyContin treatment group(control group)and OxyContin combined duloxetine group(combined group)according to the order of admission via a random number table.Patients in the control group who had previously used strong opioids were dose-switched to OxyContin,and the dosage was gradually increased until pain relief was achieved with a visual analogue scale(VAS)<3 or pain outbreaks<3.Patients in the combined group was additively given duloxetine(60 mg daily)on the basis of OxyContin(the same as the control group).VAS,quality of life(QOL),pain relief degree,Hamilton depression scale-17(HAMD-17),Hamilton anxiety scale(HAMA),dosages of OxyContin and morphine,and adverse reactions were evaluated before and after the treatment on 1,2,3 and 4 weeks.Results VAS scores were significantly decreased in both groups after the treatment(both P<0.05),and the decrease degree was significantly higher in the combined group than in the control group(P<0.05).QOL was significantly improved in both groups(both P<0.05),and the improvement was more significant in the combined group than in the control group(P<0.05).The total effective rate in the combined group and the control group was 96.7%and 73.3%,respectively(P<0.05).HAMD-17 and HAMA scores were decreased in both groups,and were both significantly decreased in the combined group than in the control group(both P<0.05).The dosage of opioids in the combined group was lower than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Oxycodone hydrochloride combined with duloxetine in the treatment of moderate and severe cancer pain has significant clinical efficacy and high safety.