三阶梯镇痛疗法联合揿针治疗癌症疼痛的临床疗效  

Clinical Efficacy of Three-Step Analgesic Therapy Combined with Pressing Needling in Treatment of Cancer Pain

作　　者：王静霞[1] 龙灿海 周小翠 郭晓冬[1] WANG Jingxia;LONG Canhai;ZHOU Xiaocui;GUO Xiaodong(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中医药学报》2022年第10期71-75,共5页Acta Chinese Medicine and Pharmacology

基　　金：国家自然科学基金青年基金项目(81704042);上海中医药大学附属岳阳中西医结合医院青年孵育项目(2019YYQ18)。

摘　　要：目的:观察三阶梯镇痛疗法联合揿针治疗癌痛的有效性、安全性,探讨揿针联合三阶梯镇痛疗法改善癌痛的潜在途径。方法:纳入70例中重度癌痛患者,随机分为治疗组和对照组,每组35例,入组后两组病例即采用三阶梯镇痛疗法进行阿片类药物滴定,NRS评分稳定至0~3分后,对照组继续三阶梯镇痛治疗;治疗组在对照组的基础上加用揿针治疗,疗程为2周,疗程结束,继续观察2周。记录两组患者NRS评分、EORTC QLQ-C30生活质量量表评分、不良反应发生情况。同时观察揿针联合三阶梯镇痛疗法治疗组治疗前后血清中内源性致痛因子降钙素基因相关肽(CGRP)及前列腺素E2(PGE2)水平的差异。结果:两组患者治疗后,NRS评分均有下降(P <0.05),且治疗组下降趋势较对照组明显(P <0.05);治疗组不良反应发生率54%(18/33)明显低于对照组84%(28/33)(P <0.01),治疗组EORTCQLQ-C30生活质量量表评分在恶心与呕吐、疼痛、食欲丧失、便秘症状改善方面优于对照组(P <0.05)。揿针联合三阶梯镇痛疗法治疗后血清PGE2、CGRP水平低于治疗前(P <0.01)。结论:三阶梯镇痛疗法联合揿针治疗癌痛疗效确切,且能减少阿片类药物不良反应,改善患者生活质量。揿针联合三阶梯镇痛疗法治疗癌痛可能与血清中PGE2和CGRP水平降低有关。Objective: To explore the efficacy and safety of three-step analgesia therapy combined with pressing needling in treatment of cancer pain,and to explore the potential way of pressing needling combined with three-step analgesia therapy to improve cancer pain. Methods: 70 patients with moderate and severe cancer pain were randomly divided into the treatment group and the control group,with 35 cases in each group. The patients in the two groups were titrated with opioids by three-step analgesic therapy. After the NRS score was stable to 0-3,the control group continued the three-step analgesic therapy;the treatment group was treated with pressing needling on the treatment basis of the control group. The course of the treatment was 2 weeks. The observation continued for another 2 weeks after the treatment. NRS scores,EORTC QLQ-C30 quality of life scale scores and adverse reactions were recorded in the two groups. At the same time,the levels of endogenous pain causing factors calcitonin gene-related peptide( CGRP)and prostaglandin E2( PGE2) were observed before and after the treatment in the treatment group. Results: NRS scores decreased after the treatment in the two groups( P < 0. 05),and the decreases in the treatment group were more significant than those in the control group( P < 0. 05). The incidence of adverse reactions in the treatment group was54%( 18/33),which was significantly lower than 84%( 28/33) of the control group( P < 0. 01). The improvements in the scores of EORTC QLQ-C30 quality of life scale,including nausea and vomiting,pain,loss of appetite and constipation,were more significant in the treatment group than those in the control group( P < 0. 05). The serum levels of PGE2 and CGRP were lower after the treatment than those before the treatment in the treatment group( P < 0. 01).Conclusion: Three-step analgesic therapy combined with pressing needling is effective in treatment of cancer pain,and it can reduce the adverse reactions of opioids and improve the life quality of the patients. The treatment

关 键 词：癌性疼痛 三阶梯镇痛疗法 揿针 

分 类 号：R246.5[医药卫生—针灸推拿学]