阿片类药物不同使用方式治疗癌痛的临床效果及癌痛与细胞因子的关系分析

Clinical effects of different use of opioids in the treatment of cancer pain and the relationship between cancer pain and cytokines

目的分析阿片类药物不同使用方式治疗癌痛的临床效果及癌痛与细胞因子的关系。方法选取2017年12月至2018年12月于长沙市第三医院血液肿瘤科进行癌痛治疗的120例肺癌患者作为研究对象,随机分为实验组与对照组,每组60例。实验组静脉持续泵入吗啡,对照组口服盐酸吗啡缓释片,比较两组临床疗效、治疗后不同时间白细胞介素-4(IL-4)和β-内啡肽(β-EP)、不良反应发生情况及分析实验组癌痛程度与细胞因子的关系。结果实验组镇痛总有效率为98.33%,高于对照组的83.33%,差异有统计学意义(P<0.05)。治疗后2、6、12、24、48h,两组IL-4水平均低于前一时间点,β-EP水平均高于前一时间点,且实验组IL-4水平低于对照组,β-EP水平高于对照组,差异有统计学意义(P<0.05)。轻度疼痛患者IL-4水平低于中重度疼痛患者,β-EP水平高于中重度疼痛患者,差异有统计学意义(P<0.05)。实验组不良反应发生率为51.66%,高于对照组的23.33%,差异有统计学意义(P<0.05)。结论静脉持续泵入吗啡治疗癌症疼痛效果显著,可降低外周血IL-4和β-EP水平,且患者外周血IL-4和β-EP水平对疼痛有一定影响,IL-4越低、β-EP水平越高,患者疼痛越轻,但该用药方式不良反应发生率较高,临床应严格控制用药剂量。

Objective To explore the clinical effects of different use of opioids in the treatment of cancer pain and the relationship between can-cer pain and cytokines.Methods A total of 120 lung cancer patients who underwent cancer pain treatment in the Hematology and Oncology depart-ment of Changsha Third Hospital from December 2017 to December 2018 were selected as the reseach subjects,and they were randomly divided into the experimental group and the control group,with 60 cases in each group.The experimental group received continuous intravenous morphine pump-ing,and the control group received oral morphine hydrochloride sustained-release tablets,the clinical efficacy,interleukin-4(IL-4)andβ-endorphin(β-EP)at different times after treatment,the incidence of adverse reactions were compared betwee the two groups,and the relationship between the degree of cancer pain and cytokines in experimental group was analyzed.Results The total effective rate of analgesic in the experimental group was 98.33%,which was higher than 83.33%in the control group,and the difference was statistically significant(P<0.05).At 2,6,12,24 and 48 h after treatment,the levels of IL-4 of the two groups was lower than that in the previous time point,and the level ofβ-EP was higher than that in the previ-ous time point,and the level of IL-4 in the experimental group was lower than that in the control group,and the level ofβ-EP was higher than that in the control group,and the differences were statistically significant(P<0.05).The level of IL-4 in the mild pain patients was lower than that in the moderate to severe pain patients,and theβ-EP level was higher than that in the moderate to severe pain patients,and the differences were statistically significant(P<0.05).The incidence rate of adverse reactions in the experimental group was 51.66%,which was higher than 23.33%in the control group,and the difference was statistically significant(P<0.05).Conclusion Intravenous continuous infusion of morphine has a significant effect on cancer pain,which can reduce the levels of IL-4 andβ-EP in peripheral blood,and the levels of IL-4 andβ-EP in the peripheral blood of patients have a certain impact on pain,the lower the level of IL-4 and the higher the level ofβ-EP,the less pain in patients,but the incidence of adverse reactions of this drug method is higher,the dosage should be strictly controlled in clinical practice.