化癌消瘤膏外敷治疗中重度癌性骨痛30例疗效观察

Clinical effect of external application of Huaai Xiaoliu ointment in treatment of moderate-to-severe cancer-induced bone pain:An analysis of 30 cases

目的:观察化癌消瘤膏外敷治疗中重度癌性骨痛阴瘤阻络证的临床疗效。方法:选择癌性骨痛阴瘤阻络证患者90例,按就诊顺序将其分为治疗组、对照1组及对照2组,每组各30例。对照1组予盐酸羟考酮缓释片治疗,并采用抑酸护胃、保肝、补液支持等基础治疗,治疗组在对照1组基础上予化癌消瘤膏外敷治疗,对照2组在对照1组基础上予唑来膦酸治疗,疗程均为7 d。比较3组治疗前后疼痛数字分级法(NRS)积分、卡氏功能状态(KPS)积分、爆发痛次数、阿片类止痛药物使用剂量及血浆内皮素-1(ET-1)水平,观察不良反应发生情况,评定综合疗效。结果:总有效率治疗组为96.6%(29/30),对照1组为83.4%(25/30),对照2组为90.0%(27/30),3组数据总体均数比较,差异有统计学意义(χ^(2)=13.169,P=0.034);治疗组、对照2组优于对照1组(P<0.05),治疗组与对照2组差异无统计学意义(P>0.05)。3组治疗前后NRS积分、KPS积分、爆发痛次数、阿片类止痛药物使用剂量及ET-1水平比较,差异均有统计学意义(P<0.05);治疗后,治疗组NPS积分、阿片类止痛药使用剂量均低于对照1、2组,KPS积分高于对照1组,爆发痛次数和ET-1水平均低于对照2组,差异均有统计学意义(P<0.05或P<0.01)。观察期间,治疗组出现2例、对照1组及对照2组分别出现1例局部皮肤瘙痒,均为轻度反应,予对症处理后症状得到控制。结论:在基础治疗上配合化癌消瘤膏外敷治疗癌性骨痛阴瘤阻络证证疗效确切,安全可靠,耐受性好,值得进一步研究推广。

Objective:To investigate the clinical effect of external application of Huaai Xiaoliu ointment in the treatment of moderate-to-severe cancer-induced bone pain with Yin tumor blocking collaterals.Methods:A total of 90 patients with cancer-induced bone pain with Yin tumor blocking collaterals were divided into treatment group,control group 1,and control group 2 according to the order by which they attended the hospital,with 30 patients in each group.The patients in control group 1 received oxycontin hydrochloride sustained-release tablets in combination with basic treatment including anti-acid therapy,liver-protecting therapy,and fluid infusion,those in the treatment group received external application of Huaai Xiaoliu ointment in addition to the treatment in control group 1,and those in control group 2 received zoledronic acid in addition to the treatment in the control group 1;the course of treatment was 7 days for all three groups.The three groups were compared in terms of numerical rating scale(NRS) pain score,Karnofsky Performance Scale(KPS) score,number of times of breakthrough pain,dose of opioid painkillers,and plasma endothelin-1(ET-1) level.Adverse reactions were observed,and overall response was assessed.Results:The overall response rate was 96.6%(29/30) in the treatment group,83.4%(25/30) in control group 1,and 90.0%(27/30) in control group 2,and there was a significant difference between the three groups(χ~2= 13.169,P=0.034);the treatment group and control group 2 had a significantly better treatment response rate than control group 1(P<0.05),while there was no significant difference between the treatment group and control group 2(P>0.05).There were significant differences between the three groups in NRS score,KPS score,the number of times of breakthrough pain,the dose of opioid painkillers,and the plasma level of ET-1 before and after treatment(P<0.05);after treatment,the treatment group had significantly lower NRS score and dose of opioid painkillers than control groups 1 and 2,a significantly higher KPS score than control group 1,and significantly lower number of times of breakthrough pain and ET-1 level than control group 2(P<0.05 or P<0.01).During observation,mild local pruritus was observed in 2 patients in the treatment group and 1 patient each in control groups 1 and 2,and the symptom was controlled after symptomatic treatment.Conclusion:External application of Huaai Xiaoliu ointment in addition to basic treatment has a marked clinical effect in the treatment of cancer-induced bone pain with Yin tumor blocking collaterals,with good safety,reliability,and tolerability,and it holds promise for further research and application.