本文關(guān)鍵詞： 骨轉(zhuǎn)移癌 癌性疼痛 益腎骨康方 影響因素　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分:癌痛程度的影響因素研究研究目的本研究通過采集癌痛患者的相關(guān)資料,分析癌痛程度的影響因素,探討其干預(yù)策略,為其綜合治療提供思路。研究方法本研究屬于描述性研究,收集患者資料,包括一般狀況、Karnofsky功能狀態(tài)評(píng)分標(biāo)準(zhǔn)、數(shù)字疼痛強(qiáng)度等。以癌痛程度為因變量,運(yùn)用SPSS軟件分析其他指標(biāo)與癌痛程度之間的相關(guān)性。研究結(jié)果本研究收集120例癌痛患者,其中中度疼痛70例,重度疼痛50例。將患者分為62歲以下(含62歲)和62歲以上,年齡與癌痛程度有關(guān)。癌痛病程與癌痛程度有關(guān),中度疼痛患者癌痛病程半年以下的有44例(62.86%),重度疼痛患者中癌痛病程半年以下的有23例(46%);而有91.43%的中度疼痛患者癌痛病程在一年以下,重度疼痛患者中只有70%,甚至有6例患者癌痛病程長達(dá)3年。本研究120例癌痛患者中有73例(60.83%)有過癌痛治療史,但是治療史與癌痛程度無關(guān)。爆發(fā)痛次數(shù)與癌痛程度有關(guān)。重度疼痛患者中爆發(fā)痛次數(shù)達(dá)3次及以上的為48例,占96%,明顯高于中度疼痛的38例,54.3%。腫瘤骨轉(zhuǎn)移可加重癌痛程度。本研究中共27例腫瘤骨轉(zhuǎn)移患者,其中有20例重度癌痛,占重度疼痛患者的40%。KPS評(píng)分與癌痛程度有關(guān)。研究結(jié)論(1)單變量分析結(jié)果顯示,年齡、癌痛病程、爆發(fā)痛次數(shù)、是否有骨轉(zhuǎn)移、KPS評(píng)分與癌痛程度有關(guān);(2)二元Logistic回歸分析結(jié)果顯示,KPS評(píng)分、爆發(fā)痛次數(shù)、是否有骨轉(zhuǎn)移與癌痛程度有關(guān)。第二部分:益腎骨康方治療骨轉(zhuǎn)移癌癌性疼痛的臨床療效研究研究目的觀察扶正解毒化瘀中藥益腎骨康方聯(lián)合三階梯止痛藥鹽酸羥考酮緩釋片對(duì)骨轉(zhuǎn)移癌疼痛患者的臨床療效和安全性。研究方法按照診斷標(biāo)準(zhǔn)共收集88例骨轉(zhuǎn)移癌疼痛患者,采用雙盲、隨機(jī)對(duì)照試驗(yàn)分為治療組和對(duì)照組各44例。治療組給予鹽酸羥考酮緩釋片和中藥益腎骨康方,對(duì)照組給予鹽酸羥考酮緩釋片和治療組中藥劑量10%的安慰劑治療。兩組治療14天后對(duì)疼痛影響評(píng)分、NRS評(píng)分、KPS評(píng)分、鹽酸羥考酮用量等主要指標(biāo)進(jìn)行治療前后組內(nèi)和組間比較,綜合評(píng)價(jià)臨床療效。研究結(jié)果治療組臨床總有效率為82%明顯優(yōu)于對(duì)照組的38.6%(P0.01)。治療組和對(duì)照組都可以減少NRS評(píng)分和爆發(fā)痛次數(shù),減少單日鹽酸羥考酮用量,且優(yōu)于對(duì)照組。治療前后,治療組可以顯著提高患者KPS評(píng)分(P0.01),而對(duì)照組治療前后KPS評(píng)分變化不顯著(P=0.302),但是兩組差異無統(tǒng)計(jì)學(xué)意義。在疼痛影響評(píng)分方面,治療后兩組各項(xiàng)評(píng)分均有所下降,而治療組比對(duì)照組在"情緒"(P=0.009)和"睡眠"(P=0.025)兩個(gè)方面有一定療效。治療組和對(duì)照組安全性評(píng)價(jià)良好,無明顯不良反應(yīng)和毒副作用。研究結(jié)論中藥益腎骨康方聯(lián)合三階梯止痛藥鹽酸羥考酮緩釋片治療骨轉(zhuǎn)移癌疼痛,較單純應(yīng)用鹽酸羥考酮緩釋片治療具有更好的止痛效果,可以改善臨床癥狀,且安全性高。
[Abstract]:The first part: research on the influencing factors of cancer pain objective this study analyzed the influencing factors of cancer pain by collecting the relevant data of cancer pain patients and discussed its intervention strategy. Methods this study is a descriptive study, collecting data of patients, including general status of Karnofsky functional state score. Digital pain intensity and so on. With cancer pain degree as a dependent variable, SPSS software was used to analyze the correlation between other indicators and cancer pain degree. Results 120 patients with cancer pain were collected in this study. There were 70 cases of moderate pain and 50 cases of severe pain. The patients were divided into two groups: under 62 years old (including 62 years old) and over 62 years old. The age was related to the degree of cancer pain, and the course of cancer pain was related to the degree of cancer pain. There were 44 cases with cancer pain less than half a year in moderate pain patients and 23 cases with cancer pain course less than half a year in severe pain patients. The course of cancer pain was less than one year in 91.43% patients with moderate pain and 70% patients with severe pain. There were even 6 patients with cancer pain for 3 years. In this study, 73 out of 120 patients with cancer pain had a history of cancer pain treatment. But the history of treatment was not related to the degree of cancer pain. The frequency of pain outbreak was related to the degree of cancer pain. Among the patients with severe pain, 48 cases (96%) had three or more outbreaks of pain, which was significantly higher than that of 38 cases of moderate pain. 54.3. Tumor bone metastasis can aggravate the degree of cancer pain. In this study, there were 27 patients with tumor bone metastasis, including 20 patients with severe cancer pain. KPS score in patients with severe pain is related to the degree of cancer pain. Conclusion 1) univariate analysis results show that age, course of cancer pain, number of pain outbreaks, whether there is bone metastasis. The KPS score was related to the degree of cancer pain. 2) the results of binary Logistic regression analysis showed that the score of KPS and the number of pain outbreaks. Whether there is bone metastasis is related to the degree of cancer pain. Part two:. Clinical study on the effect of Yishen Gu Kang recipe on Cancer pain caused by Bone Metastasis objective to observe the clinical treatment of pain patients with bone metastasis cancer treated by Yishen Gu Kang recipe combined with three ladder analgesic hydroxy codone sustained release tablets. Methods 88 patients with pain of bone metastatic carcinoma were collected according to the diagnostic criteria. A double-blind, randomized controlled trial was used to divide the treatment group into treatment group (n = 44) and control group (n = 44). The treatment group was given hydroxycodone hydrochloride sustained release tablets and Yishen Gu Kang prescription. The control group was treated with hydroxycodone hydrochloride sustained release tablets and the treatment group was treated with placebo of 10% Chinese medicine dosage. After 14 days of treatment, the pain impact score was evaluated with NRS score and KPS score in both groups. The dosage of hydroxycodone hydrochloride and other main indexes were compared before and after treatment. Results the total effective rate of the treatment group was 82% significantly better than that of the control group (38.6% P0.01). Both the treatment group and the control group reduced the NRS score and the number of pain outbreaks. Before and after treatment, the KPS score of the patients in the treatment group was significantly increased (P 0.01). In the control group, there was no significant change in KPS score before and after treatment, but there was no significant difference between the two groups. In terms of pain impact score, each score of the two groups decreased after treatment. The treatment group was more effective than the control group in two aspects: "emotion" (P0. 009) and "sleep" (P0. 025). The safety of the treatment group and the control group was good. There were no obvious adverse reactions and side effects. Conclusion Yishen Gu Kang prescription combined with three ladder analgesic hydroxycodone sustained release tablets for pain of bone metastases cancer. Compared with hydroxycodone hydrochloride sustained-release tablets alone, it has better analgesic effect, can improve clinical symptoms, and has high safety.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R730.5

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