脊神经后支脉冲射频治疗癌痛的临床观察

Clinical Observation on the Treatment of Cancer Pain by Pulsed Radio Frequency in the Posterior Branch of the Spinal Nerve

目的探讨阿片类药物配合脊神经后支脉冲射频治疗晚期恶性实体肿瘤导致的顽固性胸背及腰腹部疼痛的疗效。方法选取我院门诊及住院接受过规范的三阶梯止痛治疗的晚期中重度疼痛[视觉模拟评分量表(VAS)评分4-10分]的恶性实体肿瘤患者40例,随机分为对照组和治疗组,每组20例,对照组继续进行规范阿片类药物治疗,治疗组在规范化阿片类药物治疗基础上配合脉冲射频治疗,记录患者治疗前(T0)、治疗1周后(T1)、1个月后(T2)的VAS评分和治疗后疼痛稳定至1个月时的Karnofsky(卡氏,KPS)功能状态评分。结果 (1)治疗组在治疗后的1周、1个月的VAS评分低于对照组,治疗组在治疗前和治疗后疼痛稳定至1个月时的KPS评分高于对照组,差异有统计学意义(P<0.05);(2)治疗组20例患者中,达到完全镇痛的4例,优8例,良5例,无效3例,有效率达85%;对照组20例患者中,达到完全镇痛的3例,优7例,良3例,无效7例,有效率达65%。(3)两组便秘和尿潴留的发生率差异无明显统计学意义,但治疗组患者发生恶心呕吐、嗜睡等不良事件明显少于对照组(P<0.05)。结论阿片类药物配合脊神经后支脉冲射频治疗晚期恶性实体肿瘤导致的顽固性胸背及腰腹部疼痛安全有效,能够提高癌痛治疗的疗效,改善生存质量。

Objective To investigate the effect of opioids combined with posterior spinal nerve pulsed radio frequency on refractory thoracic and lumbar abdominal pain caused by advanced malignant solid tumors.Methods Selection specification of our hospital outpatient and in late three steps analgesic treatment of moderately severe pain[visual simulation rating scale(VAS)score 4~10]of 40 patients with malignant solid tumors were randomly divided into control group and treatment group,20 cases in each group,control group to continue the specification of opioid drug treatment,the treatment group on the basis of standardization of opioid medications with pulsed radiofrequency therapy,patients before(T0)and after 1 week treatment(T1),the VAS score and treatments after 1 month(T2)when pain is stable to a month after the Karnofsky score(KPS)function state.Results(1)The treatment group after treatment of1 week,1 month of VAS score lower than the control group,treatment group before and after treatment of pain is stable to a month KPS score higher than the control group,the difference was statistically significant(P<0.05);(2)Of the 20 patients in the treatment group,4 had complete analgesia,8 had excellent effect,5 had good effect,3 had no effect,and the effective rate reached 85%.Of the 20 patients in the control group,3 had complete analgesia,7 had excellent effect,3 had good effect and 7 had no effect,and the effective rate was 65%.(3)There was no statistically significant difference in the incidence of constipation and urinary retention between the two groups,but the incidence of nausea,vomiting,drowsiness and other adverse events in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion Opioids with spinal nerve after the pulsed radiofrequency treatment of advanced malignant solid tumors caused by intractable back and waist and abdomen pain is safe and effective,relatively simple drug therapy in the treatment of patients with some better curative effect,can improve the curative effect of treatment of pain,improve the quality of life.