揿针联合阿片类镇痛药物治疗中重度癌性疼痛的临床疗效及对血清β-内啡肽、P物质水平的影响  

Clinical efficacy of press needle combined with opioid analgesics in treating moderate-to-severe cancer pain and its effect on serum levels ofβ-endorphin and substance P

作　　者：周小翠 王立玉[1] 季锋 龙灿海 王静霞[1] 郭晓冬[1] 谢国群 ZHOU Xiaocui;WANG Liyu;JI Feng;LONG Canhai;WANG Jingxia;GUO Xiaodong;XIE Guoqun(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,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 [2]上海中医药大学,上海201203

出　　处：《上海中医药杂志》2023年第1期71-75,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81704042);上海中医药大学附属岳阳中西医结合医院院级基金项目(2019YYQ18)。

摘　　要：目的观察揿针联合阿片类镇痛药物治疗中重度癌性疼痛的临床疗效及对血清β-内啡肽、P物质水平的影响。方法将76例中重度癌性疼痛患者随机分为治疗组、对照组,每组38例。对照组给予常规治疗(包括积极治疗原发病、营养支持、阿片类镇痛药物止痛治疗等),治疗组在常规治疗的基础上加用揿针疗法,连续治疗14 d。观察不良反应的发生情况,比较治疗前后两组患者疼痛数字评分(NRS)、简明疼痛量表(BPI)、卡氏功能状态评分(KPS),以及血清β-内啡肽、P物质水平的变化情况。结果①试验期间,治疗组脱落4例,对照组脱落3例,最终完成试验者69例,其中治疗组34例、对照组35例。②治疗前后组内比较,治疗组疼痛NRS评分降低、KPS评分升高(P<0.05),对照组疼痛NRS、KPS评分差异无统计学意义(P>0.05);组间治疗后比较,治疗组疼痛NRS评分低于对照组、KPS评分高于对照组(P<0.05)。③治疗前后组内比较,治疗组BPI中24 h最剧烈疼痛、24 h平均疼痛、目前疼痛、对日常生活影响、对情绪影响、对日常工作影响、对睡眠影响及疼痛影响程度总评分降低(P<0.05),对行走能力影响评分升高(P<0.05),对照组上述指标差异无统计学意义(P>0.05);组间治疗后比较,上述指标差异无统计学意义(P>0.05)。④治疗前后组内比较,两组血清β-内啡肽水平升高、P物质水平降低(P<0.05);组间治疗后比较,治疗组血清P物质水平低于对照组(P<0.05)。⑤治疗组便秘、恶心呕吐发生率及不良反应总发生率低于对照组(P<0.05)。结论加用揿针对癌性疼痛患者具有更好的临床疗效,可缓解疼痛、改善患者生活质量、降低阿片类镇痛药物的不良反应发生率,其机制可能与调节血清β-内啡肽、P物质表达水平有关。Objective To observe the clinical efficacy of press needle combined with opioid analgesics in treating moderate-to-severe cancer pain and its effect on serum levels ofβ-endorphin and substance P.Methods Seventy-six patients with moderate-to-severe cancer pain were randomized into a treatment group(n=38)and a control group(n=38).Patients in the control group received conventional treatment(including active treatment of primary diseases,nutritional support,and opioid analgesics)while those in the treatment group were treated with press needle in addition to the conventional treatment.The treatment in both groups lasted 14 consecutive days.The incidence of adverse reactions was observed,and the pain numerical rating scale(NRS),Brief Pain Inventory(BPI),Karnofsky Performance Status(KPS),and serum levels ofβ-endorphin and substance P were assessed and compared before and after treatment.Results①There were 4 drop-outs in the treatment group and 3 drop-outs in the control group during the trial.Finally,69 patients completed the trial with 34 patients in the treatment group and 35 patients in the control group.②After treatment,the pain NRS score decreased and KPS score increased in the treatment group(P<0.05),while the differences before and after treatment in pain NRS and KPS scores in the control group were not statistically significant(P>0.05);After treatment,the pain NRS score in the treatment group was lower than that in the control group and the KPS score in the treatment group was higher than that in the control group(P<0.05).③In the treatment group,the scores of worst pain in last 24 hours,pain on average over the last 24 hours,pain right now,impact on general activity,mood,normal work,sleep,and total score of impact of pain after treatment were lower than those before treatment(P<0.05),and the scores of impact on walking ability increased after treatment(P<0.05),but the differences before and after treatment in the scores of the above items in the control group were not statistically significant(P>0.05);

关 键 词：癌性疼痛 揿针 阿片类药物 Β-内啡肽 中西医结合疗法 不良反应 临床试验 

分 类 号：R730.5[医药卫生—肿瘤]