温阳止痛贴阿是穴穴位贴敷联合艾灸治疗虚寒型癌性疼痛患者的疗效及对血清炎性因子的影响

Effect of Wenyang Zhitong Plaster Combined with Moxibustion at Ashipoint on Cancer Pain of Deficiency Cold Type and Its Influence on Serum Inflammatory Factors

目的探讨温阳止痛贴阿是穴穴位贴敷联合艾灸治疗虚寒型癌性疼痛患者的疗效及对血清炎性因子的影响。方法选取2017年1月—2020年12月期间沧州中西医结合医院住院的120例癌痛患者作为研究对象,根据随机数字法将其分为对照组和治疗组,每组各60例。对照组按照WHO三阶梯止痛原则予以药物止痛治疗,治疗组在对照组的基础上予以温阳止痛贴阿是穴穴位贴敷联合艾灸。治疗15 d后,观察比较两组患者疼痛情况(NRS评分、疼痛缓解时间、每日爆发痛次数)、生活质量(KPS评分)、中医症状评分、炎性因子水平[前列腺素E_(2)(Prostaglandin E_(2),PGE_(2))、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、β-内啡肽(β-endorphin,β-EP)]、临床疗效及不良反应情况。结果治疗后治疗组总有效率90.00%(54/60)明显高于对照组83.33%(50/60),差异有统计学意义(χ^(2)=7.925,P=0.048,P<0.05)。治疗后两组患者NRS评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组NRS评分较对照组明显降低,差异有统计学意义(P<0.05)。另治疗后治疗组疼痛缓解时间较对照组明显延长,每日爆发痛次数较对照组明显减少,差异有统计学意义(P<0.05)。治疗后两组患者KPS评分均较治疗前升高,中医症状评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组KPS评分较对照组明显升高,中医症状评分较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者PGE_(2)、TNF-α、IL-6水平均较治疗前降低,β-EP水平均较治疗前升高,差异有统计学意义(P<0.05);且治疗组PGE_(2)、TNF-α、IL-6水平均较对照组降低,β-EP水平较对照组升高,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(χ^(2)=0.288,P=0.789,P>0.05)。结论温阳止痛贴阿是穴穴位贴敷联合艾灸可增强止痛药的镇痛效果,延长疼痛缓解时间并减少爆发痛次数,改善患者炎性因子水平及生活质量,提高临床疗效。

Objective To explore the curative effect of Wenyang Zhitong plaster combined with moxibustion atashipoint on cancer pain of deficiency cold type and its influence on serum inflammatory factors.Methods A total of 120 patients with cancer pain hospitalized in Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from January 2017 to December 2020 were selected and divided into control group and treatment group according to the random number table,with 60 in each group.The control group was given medication according to the WHO three-step analgesic ladder,and the treatment group received Wenyang Zhitong plaster at ashipoint combined with moxibustion on the basis of the control group.After 15 d of treatment,the pain[numeric rating scale(NRS)score,pain release time,number of pain outbreaks],quality of life[Karnofsky performance status(KPS)score],traditional Chinese medicine(TCM)symptom score,level of inflammatory factors[prostaglandin E_(2)(PGE_(2)),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),β-endorphin(β-EP)],clinical efficacy and adverse reactions of the two groups were observed and compared.Results The total effective rate of the treatment group was 90%(54/60),higher than 83.33%(50/60)of the control group(χ^(2)=7.925,P=0.048,P<0.05).After treatment,the NRS score,TCM syndrome score,and PGE_(2),TNF-α,IL-6 levels of the two groups were lower than those before treatment(P<0.05),and the treatment group had more obvious decrease than the control group(P<0.05).Compared with the conditions of the control group,.The pain relief time of the treatment group was longer,and the number of daily pain outbreaks was less(P<0.05).After treatment,the KPS score andβ-EP of the two groups were higher than those before treatment(P<0.05),and the treatment group had more obvious elevation than the control group(P<0.05).There was no skin injury such as scald in both groups,and no significant difference was observed in adverse reactions such as nausea,vomiting and constipation(χ^(2)=0.288,P=0.789,P>0.05).Conclusion Wenyang Zhitong plaster combined with moxibustion at ashipoint could enhance the analgesic effect of analgesics,prolong the pain relief time,reduce the number of pain outbreaks,improve the level of inflammatory factors and quality of life of patients,and enhance the clinical efficacy.