羟考酮联用抗抑郁药治疗癌性疼痛:有效性和安全性的Meta分析  

Oxycodone combined with anti-depressants for cancer pain:a meta-analysis of efficacy and safety

作　　者：宋爽 蒋运兰[2] 李滔 康静 杜秋凤 易晓冬 SONG Shuang(Chengdu University of Traditional Chinese Medicine,Chengdu 610075,Sichuan,China)

机构地区：[1]成都中医药大学护理学院 [2]成都中医药大学附属医院,四川成都610072

出　　处：《牡丹江医学院学报》2024年第2期126-132,106,共8页Journal of Mudanjiang Medical University

基　　金：四川省中医药管理局项目(2021MS159)。

摘　　要：目的系统评价羟考酮联合抗抑郁药物治疗癌性疼痛的有效性和安全性。方法计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library等数据库,收集有关羟考酮联合抗抑郁药物治疗癌性疼痛的随机对照试验研究,检索时间均限定为建库至2023年7月。由2名研究人员根据纳入与排除标准进行独立的文献筛选、资料提取及质量评价。运用RevMan 5.4进行数据合并与分析。结果最终纳入18项研究,共1399例癌痛患者。Meta分析结果显示,对比单药治疗,羟考酮联合抗抑郁药物治疗癌性疼痛在临床治疗总有效率[RR=1.28,95%CI(1.17,1.41),P<0.001]、疼痛程度评分[MD=-0.92,95%CI(-1.10,-0.74),P<0.001]、羟考酮日均用量[MD=-15.64,95%CI(-23.91,-7.37),P<0.001]、爆发性痛发生次数[MD=-0.60,95%CI(-0.68,-0.52),P<0.001]、抑郁[SMD=-2.99,95%CI(-3.91,-2.07),P<0.001]、焦虑评分[SMD=-2.26,95%CI(-3.42,-1.10),P<0.001]方面更具优势。在不良反应发生方面,羟考酮联用抗抑郁药物能显著减少便秘的发生率[RR=0.81,95%CI(0.70,0.93),P<0.001],且不增加恶心呕吐、头晕嗜睡、排尿障碍、皮肤瘙痒、食欲不振的发生率,差异无统计学意义(P>0.05)。羟考酮联合抗抑郁药物可能增加口干的发生风险[RR=2.30,95%CI(1.19,4.45),P=0.01],但该项Meta分析结果敏感性较高,缺乏稳健性。按抗抑郁药物类别进行亚组分析,结果与上述Meta分析结果一致。结论当前证据表明,羟考酮联合抗抑郁药物治疗癌痛的临床疗效较好,安全性较高。但由于其可能增加口干的风险,临床运用时在临床应用中应权衡利弊,使癌症患者获得更优的镇痛方案。因所纳文献的数量与质量的局限性,上述结论有待进一步验证。Objective To systematically evaluate the effectiveness and safety of oxycodone combined with anti-depressant drugs in the treatment of cancer pain.Methods Computerized searches of CNKI,VIP,Wanfang,CBM,PubMed,Embase,Web of Science,Cochrane Library and other databases were conducted to collect randomized controlled trial studies on oxycodone combined with anti-depressant drugs for the treatment of cancer pain limited to the period from July 2023.Independent literature screening,data extraction,and quality assessment were performed by 2 researchers based on inclusion and exclusion criteria.Data were merged and analyzed using RevMan5.4.Results Eighteen studies with a total of 1399 patients with cancer pain were finally included.Meta-analysis showed that compared with monotherapy,oxycodone combined with antidepressant medication for the treatment of cancer pain showed a significant difference in the overall clinical treatment efficacy rate[RR=1.28,95%CI(1.17,1.41),P<0.001],pain level score[MD=-0.92,95%CI(-1.10,-0.74),P<0.001],average daily dosage of oxycodone[MD=-15.64,95%CI(-23.91,-7.37),P<0.001],number of episodes of explosive pain[MD=-0.60,95%CI(-0.68,-0.52),P<0.001],depression[MD=-2.99,95%CI(-3.91,-2.07),P<0.001],and anxiety scores[SMD=-2.26,95%CI(-3.42,-1.10),P<0.001]were more favorable.Regarding the occurrence of adverse effects,oxycodone combined with anti-depressants significantly reduced the incidence of constipation[RR=0.81,95%CI(0.70,0.93),P<0.001]and did not increase the incidence of nausea,vomiting,dizziness,somnolence,urinary disorders,skin itching,and loss of appetite(P>0.05).Oxycodone combined with antidepressants may increase the risk of dry mouth[RR=2.30,95%CI(1.19,4.45),P=0.01],but the results of this Meta-analysis had high sensitivity and lacked robustness.Subgroup analyses by anti-depressant drug class showed results consistent with those of the Meta-analysis described above.Conclusion Current evidence suggests that oxycodone in combination with anti-depressants is clinically efficacy and safe in

关 键 词：羟考酮 阿片类药物 抗抑郁药 癌痛 疗效 META分析 

分 类 号：R730.5[医药卫生—肿瘤]