盐酸文拉法辛胶囊联合羟考酮缓释片治疗中重度癌痛的临床研究  

Clinical Therapeutic Effect of Oxycodone Hydrochloride Controlled-release Tablets Combined with Venlafaxine Hydrochloride Capsules for Advanced Cancer Pain

作　　者：丁亚文[1] 冯刚[1] 张丽娟[1] 伍明超 王晓娟[1] 万复甦[1] 陈伟[1] 张金玲[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院肿瘤科,武汉430033 [2]武汉市优抚医院精神科,武汉430023

出　　处：《华中科技大学学报（医学版）》2012年第4期485-489,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨不同类型的抗抑郁药联合盐酸羟考酮缓释片治疗伴有抑郁症状的晚期中重度癌痛患者的临床疗效及对其免疫功能的影响。方法 71例晚期恶性肿瘤伴疼痛的患者,采取随机的方法分为3组,A组:盐酸羟考酮缓释片组22例;B组:盐酸羟考酮缓释片+阿米替林片组26例;C组:盐酸羟考酮缓释片+盐酸文拉法辛胶囊组23例。当患者达到疼痛缓解时维持给药,观察比较治疗前后的疼痛缓解程度、抑郁症状、生活质量和毒副反应,同时检测疼痛介质[5-羟色胺(5-HT)、去甲肾上腺素(NE)]和免疫功能指标(IgG、IgA、IgM、补体C3、补体C4;CD4+T细胞、CD8+T细胞、NK细胞)的变化。结果①疼痛缓解程度:3组疼痛均有不同程度的减轻,C组大于A组和B组(均P<0.05);②抑郁症状:C组抑郁症状缓解的程度大于A组和B组(均P<0.05);③生活质量(Quality of life,QOL):C组较A组明显提高(P<0.05);④毒副反应:C组发生率均低于B组(均P<0.05);⑤疼痛介质的检测结果:3组在治疗后均低于治疗前(均P<0.05);⑥免疫功能指标:3组在治疗后均高于治疗前(均P<0.05)。结论盐酸文拉法辛胶囊联合盐酸羟考酮缓释片能有效地控制癌痛,缓解抑郁症状,改善免疫功能,提高患者生活质量。Objective To investigate the clinical efficacy of oxycodone hydrochloride controlled-release tablets combined with antidepressants for moderate to severe pain in advanced cancer patients with depression and their effects on immune function.Methods Randomized and case-controlled clinical trial was conducted.Seventy-one patiens who suffered pain due to advanced were randomized into three groups：group A given oxycodone hydrochloride controlled-release tablets（n=22）,group B given oxycodone hydrochloride controlled-release tablets＋amitriptyline tablets（n=26）,and group C given hydrochloride controlled-release tablets＋venlafaxine hydrochloride capsules（n=23）.When the patients with advanced cancer were given a quick relief,the maintenance dosage was used.We recorded the pain score by NRS,the degree of pain relief,side effect,the quality of life,and depressive symptoms,tested the mediators releated to pain,detected CD＋4T cells,CD＋8T cells and NK cells by flow cytometry,and measured NE,5-HT,IgG,IgA and IgM by ELISA.Results The pain relief in group C was more significant than in groups A and B（both P〈0.05）.The depressive relief was more significant in group C than in groups A and B（P〈0.05）.The quality of life in group C was significantly improved as compared with group A（P〈0.05）.The incidence of toxic side effects in group C was lower than in group B（P〈0.05）.The levels of mediators（5-HT,NE）related to pain in three groups after treatment were lower than those before treatment（P〈0.05）.The levels of IgG,IgA,IgM,CD＋4T cells,CD＋8 T cells and NK cells in all groups after treatment were higher than those before treatment（P〈0.05）.Conclusion The combined use of oxycodone hydrochloride controlled-release tablets and venlafaxine hydrochloride capsules can synergistically and effectively reduce cancer pain,alleviate depressive symptoms,improve immune function,and improve the life quality of advanced cancer patients.

关 键 词：盐酸文拉法辛 盐酸羟考酮 癌痛 抗抑郁药 免疫功能 

分 类 号：R441.1[医药卫生—诊断学]