腕踝针联合吗啡治疗难治性癌痛16例临床观察

Clinical Observation on Wrist-Ankle Acupuncture Combined with Morphine in the Treatment of 16 Cases of Refractory Cancer Pain

目的评价腕踝针联合吗啡治疗难治性癌痛患者的镇痛效果。方法将53例难治性癌痛患者随机分为吗啡组18例、吗啡+针刺组17例、吗啡+腕踝针组18例。吗啡组根据疼痛强度分别给予相应剂量的吗啡缓释片口服治疗;吗啡+针刺组在给予吗啡缓释片后立即针刺双侧内关、三阴交,留针1 h;吗啡+腕踝针组在给予吗啡缓释片后立即联合腕踝针治疗,留针1 h。观察各组患者镇痛效果,记录患者镇痛起效时间、镇痛持续时间、爆发痛次数,并分别于治疗前后记录各组患者吗啡使用量、KPS评分,采用数字分级法(NRS)评估患者疼痛强度。治疗过程观察并记录患者不良反应。结果吗啡组、吗啡+针刺组及吗啡+腕踝针组镇痛总有效率分别为68. 8%、75. 0%和87. 5%,吗啡+腕踝针组镇痛总有效率优于吗啡组(P <0. 05)。与吗啡组比较,吗啡+针刺组、吗啡+腕踝针组镇痛起效时间均缩短,镇痛持续时间延长,爆发痛次数减少(P <0. 05或P <0. 01);与吗啡+针刺组比较,吗啡+腕踝针组镇痛起效时间缩短,镇痛持续时间延长,爆发痛次数减少(P <0. 05)。与吗啡组治疗后比较,吗啡+针刺组吗啡使用量减少,吗啡+腕踝针组NRS评分降低、KPS评分升高、吗啡使用量减少(P <0. 05或P <0. 01);与吗啡+针刺组治疗后比较,吗啡+腕踝针组NRS评分降低、KPS评分升高、吗啡使用量减少(P <0. 05)。吗啡组、吗啡+针刺组及吗啡+腕踝针组患者不良反应发生率分别为56. 25%、43. 75%和18. 75%,吗啡+腕踝针组不良反应发生率明显低于吗啡组及吗啡+针刺组(P <0. 05)。结论腕踝针联合吗啡治疗难治性癌痛患者效果确切,并能减少吗啡使用量,减少不良反应的发生。

Objective To evaluate the analgesic effects of wrist-ankle acupuncture combined with morphine in the treatment of refractory cancer pain.Methods Fifty-three patients with refractory caner pain were randomly assigned to morphine group(18 cases),morphine plus acupuncture group(17 cases)and morphine plus wrist-ankle acupuncture group(18 cases).The morphine group was given oral administration of morphine sustained-release tablets according to the intensity of pain.The morphine plus acupuncture group was given acupuncture at bilateral Neiguan(PC6),Sanyinjiao(SP6)immediately after giving the morphine sustained-release tablets,and the needles were retained for 1 hour;the morphine plus wrist-ankle acupuncture group was given wrist-twisting acupuncture immediately after giving the morphine sustained-release tablets,and the needles were retained for 1 hour.The analgesic effects on patients of all groups were observed.The onset time of analgesia,duration of analgesia,and the number of pain outbreaks were recorded.The morphine dose and KPS score before and after treatment were recorded.The numerical rating scale(NRS)was used to assess the pain level of patients.Adverse reaction during treatment was also recorded.Results The total analgesic effective rate of the morphine group,the morphine plus acupuncture group and morphine plus wrist-ankle group was 68.8%,75.0%and 87.5%,respectively.The total analgesic effect of morphine plus wrist-ankle group was better than that of the morphine group(P<0.05).Compared with the morphine group,the analgesic onset time of the morphine plus acupuncture group,and the morphine plus wrist-ankle group was shortened,the duration of analgesia was prolonged,and the number of outbreaks was reduced(P<0.05 or P<0.01).Compared with the morphine plus acupuncture group,the analgesic onset time of the morphine plus wristankle group was shortened,the duration of analgesia was prolonged,and the number of outbreaks was reduced(P<0.05).Compared with the morphine group after treatment,the morphine use of the morphine plus acupuncture group was reduced,and the NRS score of the morphine plus wrist-ankle group was reduced,KPS score increased,and the morphine dose was reduced(P<0.05 or P<0.01).Compared with the morphine plus acupuncture group after treatment,the NRS score of the morphine plus wrist-ankle group was reduced,KPS score increased,and the morphine dose was reduced(P<0.05).The incidence of adverse reactions in the morphine group,the morphine plus acupuncture group and the morphine plus wrist-ankle group was 56.25%,43.75%and 18.75%,respectively.The incidence of adverse reactions in the morphine plus wrist-ankle group was significantly lower than that in the morphine group and morphine plus acupuncture group(P<0.05).Conclusion Wrist-ankle acupuncture combined with morphine in the treatment of refractory cancer pain is effective,and it could reduce the use of morphine and reduce the incidence of adverse reactions.