口服或皮下注射吗啡在晚期癌痛患者镇痛治疗中的应用价值对比

Comparison on application value of oral or subcutaneous morphine for analgesia in analgesic treatment of advanced cancer pain patients

目的对比吗啡不同给药方式在晚期癌痛患者镇痛治疗中的应用效果。方法对70例晚期癌痛患者进行回顾性研究,按照吗啡不同给药方式分为口服组(35例)和注射组(35例)。口服组予以盐酸羟考酮缓释片联合盐酸吗啡缓释片治疗,注射组予以盐酸羟考酮缓释片联合盐酸吗啡注射液治疗。对比两组疼痛程度、疼痛缓解情况、临床镇痛指标及不良反应发生情况。结果治疗前与治疗1 d后,两组疼痛数字评分法(NRS)评分相比,无统计学意义(P>0.05);治疗3、7 d后,注射组NRS评分分别为(3.06±0.18)、(1.93±0.23)分,均低于口服组的(3.28±0.24)、(2.63±0.19)分,有统计学意义(P<0.05)。治疗后,注射组的总有效率(94.29%)高于口服组(88.57%),但无统计学意义(P>0.05)。治疗后,两组β-内啡肽(β-EP)水平较治疗前上升,前列腺素E2(PGE2)和5-羟色胺(5-HT)水平均较治疗前下降,有统计学意义(P<0.05)。治疗后,注射组β-EP(188.16±6.32)ng/L较口服组的(162.31±6.47)ng/L高,PGE2(36.59±5.62)ng/L、5-HT(122.65±7.23)ng/L均较口服组的(42.67±6.43)、(149.46±7.68)ng/L低,有统计学意义(P<0.05)。注射组的不良反应总发生率(22.86%)和口服组(17.14%)相比,无统计学意义(P>0.05)。结论盐酸羟考酮缓释片联合吗啡皮下注射的临床效果相较于口服吗啡更为显著,能够进一步缓解患者的疼痛程度,降低临床疼痛指标,且安全性良好。

Objective To compare the application effect of oral or subcutaneous morphine for analgesia in analgesic treatment of advanced cancer pain patients.Methods A retrospective study was conducted on 70 patients with advanced cancer pain,and they were divided into an oral group(35 cases)and an injection group(35 cases)according to different treatment methods.The control group was given oxycodone hydrochloride sustained-release tablets combined with morphine hydrochloride sustained-release tablets,and the injection group was given oxycodone hydrochloride sustained-release tablets combined with morphine hydrochloride injection.The pain level,pain relief,clinical analgesia indexes,and occurrence of adverse reactions were compared between the two groups.Results There was no significant difference in numerical rating scale(NRS)scores between the two groups before treatment and 1 d after treatment(P>0.05).3 and 7 d after treatment,the NRS scores in the injection group were(3.06±0.18)and(1.93±0.23)points,which were lower than(3.28±0.24)and(2.63±0.19)points in the oral group,and there was statistical significance(P<0.05).After treatment,the total effective rate of the injection group(94.29%)was higher than that of the oral group(88.57%),but there was no statistical significance(P>0.05).After treatment,theβ-endorphin(β-EP)levels in both groups were increased,and the prostaglandin E2(PGE2)and 5-hydroxytryptamine(5-HT)levels were decreased,and there was statistical significance(P<0.05).After treatment,β-EP in the injection group was(188.16±6.32)ng/L,which was higher than(162.31±6.47)ng/L in the oral group;the PGE2 in the injection group was(36.59±5.62)ng/L and 5-HT was(122.65±7.23)ng/L,which were lower than(42.67±6.43)and(149.46±7.68)ng/L in the oral group;there was statistical significance(P<0.05).There was no statistical significance in the total incidence of adverse reactions between the injection group(22.86%)and the oral group(17.14%)(P>0.05).Conclusion The clinical effect of subcutaneous injection of oxycodone hydrochloride sustained-release tablets combined with morphine is more significant than that of oral morphine,which can further relieve patients'pain and reduce clinical pain indicators with high safety.