双氯芬酸与塞来昔布联合阿片类药物控制转移性骨癌痛的临床疗效

Clinical Efficacy of Diclofenac and Celecoxib Combined with Opioid on Metastatic Bone Cancer Pain

目的探讨双氯芬酸与塞来昔布联合阿片类药物控制转移性骨癌痛的临床效果。方法将82例转移性骨癌痛患者随机分为研究组和对照组,每组41例。研究组患者给予硫酸吗啡控释片10 mg/12 h口服,依据疼痛缓解情况按50%递减或25%递增调解用药量,直至VAS评分≤4分,塞来昔布400 mg/d口服,双氯芬酸100 mg/12 h口服。对照组患者给予硫酸吗啡控释片10 mg/12 h口服,依据疼痛缓解情况按50%递减或25%递增调解用药量,直至VAS评分≤4分,塞来昔布400 mg/d口服,以及安慰剂。对比2组患者疼痛视觉模拟评分(VAS)、疼痛缓解率、暴发痛发作次数、硫酸吗啡控释片使用剂量及药物不良反应。结果 (1)研究组患者治疗后各时段VAS评分显著低于对照组(P<0.01)。(2)研究组患者疼痛缓解率显著高于对照组(P<0.05,P<0.01);(3)2组患者暴发痛发作次数较治疗前均显著降低(P<0.05),且研究组患者较对照组降低更显著(P<0.05);(4)研究组患者硫酸吗啡控释片日均用量及不良反应发生率均明显低于对照组(P<0.05)。结论双氯芬酸与塞来昔布联合阿片类药物控制转移性骨癌痛的临床效果显著,安全可靠,具有临床应用价值。

Objective To evaluate the clinical efficacy of diclofenac and celecoxib combined with opioid on metastatic bone cancer pain. Methods 82 patients with metastatic bone cancer pain were randomly divided into the study group and the control group,41 patients in each group. The study group were treated with morphine sulfate 10 mg /12 h,adding 50% or reducing25% according to pain level until VAS ≤4,diclofenac 100 mg /12 h,celecoxib 400 mg / d. The control group were treated with morphine sulfate 10 mg /12 h,adding 50% or reducing 25% according to pain level until VAS≤4,celecoxib 400 mg / d and placebo. The visual analogue scale,pain relief rates,breakthrough pain times,morphine sulfate dose and adverse reactions between the2 groups were compared. Results The VAS in the study group after treatment was significantly less than that of the control group( P < 0. 01). The pain relief rate in the study group was significantly higher than that of the control group( P < 0. 05,P < 0. 01).The breakthrough pain times in the study group after treatment were significantly less than those of the control group( P < 0. 05).The morphine sulfate dose and adverse reactions in the study group was significantly less than that of the control group( P <0. 05). Conclusion Diclofenac and celecoxib combined with opioid on metastatic bone cancer pain is effective and safe,it is worthy of clinical application.