盐酸羟考酮与吗啡用于晚期癌性疼痛患者的镇痛作用及对睡眠质量影响的比较

Comparison of Effects of Oxycodone Hydrochloride and Morphine on Analgesia and Sleep Quality of Patients with Advanced Cancer Pain

目的:比较盐酸羟考酮与吗啡用于晚期癌性疼痛患者的镇痛作用及对睡眠质量的影响。方法:选取2019-2020年秦皇岛市第四医院收治的晚期癌性疼痛患者266例,以信封法随机分为对照组和研究组,每组133例。对照组患者使用吗啡治疗,研究组患者使用盐酸羟考酮治疗。采用视觉模拟评分(visual analogue scale,VAS)评估两组患者滴定前、滴定开始后24 h和转换为控/缓释型强阿片类药物72 h后的疼痛程度,比较治疗前后血清5-羟色胺(5-HT)、多巴胺(DA)及脑源性神经营养因子(BDNF)水平,观察治疗前后帕金森病综合评分量表(unified Parkinson’s disease rating scale,UPDRS)、帕金森睡眠量表(Parkinson’s disease sleep scale,PDSS)和匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分情况,比较治疗前后炎症因子水平,观察不良反应发生情况。结果:研究组患者转换后72 h的VAS评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组患者UPDRS、PSQI评分明显低于对照组,PDSS评分明显高于对照组,差异均有统计学意义(P<0.05)。治疗后,研究组患者5-HT、BDNF水平明显高于对照组,DA水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,研究组患者γ干扰素、白细胞介素2水平明显高于对照组,白细胞介素4水平明显低于对照组,差异均有统计学意义(P<0.05)。研究组患者的不良反应发生率为15.79%(21/133),明显低于对照组的31.58%(42/133),差异有统计学意义(χ^(2)=9.172,P=0.002)。结论:盐酸羟考酮与吗啡在晚期癌性疼痛患者快速滴定过程中的有效性相似,口服盐酸羟考酮的效果较吗啡更好,可明显减轻患者的炎症反应和不良反应,提高睡眠质量。

OBJECTIVE:To compare the effects of oxycodone hydrochloride and morphine on analgesia and sleep quality of patients with advanced cancer pain.METHODS:Totally 266 patients with advanced cancer pain admitted into the Qinhuangdao Fourth Hospital from 2019 to 2020 were extracted to be divided into the control group and the study group via the envelope method,with 133 cases in each group.The control group was treated with morphine,while the study group received oxycodone hydrochloride.Visual analogue scale(VAS)was used to assess the pain degree before titration,24 h after titration,and 72 h after conversion of controlled/sustained release strong opioids.The serum levels of 5-hydroxytryptamine(5-HT),dopamine(DA)and brain-derived neurotrophic factor(BDNF)were compared between two groups before and after treatment.Unified Parkinson’s disease rating scale(UPDRS),Parkinson’s disease sleep scale(PDSS)and Pittsburgh sleep quality index(PSQI)of two groups were observed before and after treatment.The levels of inflammatory factors were compared between two groups before and after treatment,and the occurrence of adverse drug reactions was observed.RESULTS:The VAS scores of the study group at 72 h after conversion were significantly lower than those of the control group,the difference was statistically significant(P<0.05).After treatment,the UPDRS and PSQI scores of the study group were significantly lower than those of the control group,and the PDSS scores were significantly higher than those of the control group,with statistically significant differences(P<0.05).After treatment,the 5-HT and BDNF levels of the study group were significantly higher than those of the control group,and the DA concentration was significantly lower than that of the control group,the differences were statistically significant(P<0.05).After treatment,the levels of interferon-γand interleukin 2 in the study group were significantly higher than those in the control group,and the levels of interleukin 4 were significantly lower than those in the control group,with statistically significant differences(P<0.05).The incidence of adverse drug reactions in the study group was 15.79%(21/133),significantly lower than 31.58%(42/133)in the control group,the difference was statistically significant(χ^(2)=9.172,P=0.002).CONCLUSIONS:The effectiveness of oxycodone hydrochloride is similar to that of morphine during rapid titration in patients with advanced cancer pain.Oral oxycodone hydrochloride is more effective than morphine and can significantly reduce the inflammatory reactions and adverse drug reactions,improve the sleep quality in patients.