奥氮平联合地塞米松治疗阿片类药物胃肠道反应的临床疗效观察

Clinical observation of olanzapine combined with dexamethasone in the treatment of gastrointestinal reaction of opioid

目的探讨奥氮平联合地塞米松在治疗阿片类药物胃肠道反应中的临床疗效。方法收集2019年1月1日至2020年10月31日在我院收治的应用阿片类药物治疗的癌痛患者共72例,按照随机数字表法分为奥氮平联合组(A组)及胃复安组(B组)各36例,A组采用奥氮平联合地塞米松口服,B组给予甲氧氯普胺片口服,观察两组在治疗阿片类药物胃肠道反应中的临床疗效及不良反应。结果A组止吐有效率75%高于B组44%(P<0.05)。治疗后,两组SAS及SDS评分均降低,A组QLQ-C30评分升高,且A组SAS、SDS、QLQ-C30均优于B组(P<0.05)。治疗后,A组白蛋白及前白蛋白均高于B组,体重减轻及便秘的不良反应例数明显低于B组,嗜睡高于B组,差异均有统计学意义(P<0.05)。结论奥氮平联合地塞米松方案可改善阿片类药物出现的胃肠道反应,改善呕吐、焦虑抑郁及生活质量,用法方便、安全、患者耐受性好,值得临床推广。

Objective To explore the clinical efficacy of olanzapine and dexamethasone in the treatment of gastrointestinal reaction of opioid.Methods A total of 72 patients with cancer pain treated with opioids in our hospital from January 1,2019 to October 31,2020 were selected.The patients were divided into a group A treated with olanzapine combined with dexamethasone and a group B treated with metoclopramide by using random number table method,36 in each group.The clinical efficacy in the treatment of opioid gastrointestinal reaction of the two groups was observed,and the toxic and side effects of the two groups were analyzed.Results The effective rate of antiemetic in the group A was 75%,which was higher than 44%in the group B(P<0.05).After treatment,the scores of Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were decreased in both groups and Quality of Life Core Questionnaire 30(QLQ-C3)score in the group A was increased,and the scores of SAS,SDS,and QLQ-C3 in the group A were better than those in the group B(P<0.05).After treatment,albumin and prealbumin were higher,the number of adverse reactions such as weight loss and constipation were significantly lower,and sleepiness was higher in the group A than those in the group B(P<0.05).Conclusion Olanzapine combined with dexamethasone has achieved certain effects in Improving antiemetic,anxiety and depression,and quality of life of patients with gastrointestinal reactions caused by opioids.It is convenient,safe,and well tolerated by patients.It is worthy of clinical promotion.