發(fā)布時(shí)間：2018-03-02 02:17

  本文關(guān)鍵詞： 癌性疼痛 三階梯止痛方法 脊神經(jīng)節(jié)段分布 背俞穴 穴位埋線 生存質(zhì)量 醫(yī)院焦慮抑郁狀態(tài)　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：背景：癌癥患者自覺(jué)的癌性疼痛,主要指腫瘤細(xì)胞的浸潤(rùn)、擴(kuò)散、轉(zhuǎn)移或壓迫相關(guān)組織所引起的,是眾多癥狀中發(fā)生率最高的。盡管有“三階梯止痛”國(guó)際公認(rèn)的方法來(lái)治療癌痛,但仍未能做到控制所有的癌痛。穴位埋線療法具有鎮(zhèn)痛效果重、刺激效力長(zhǎng)、不需反復(fù)操作的優(yōu)勢(shì)。為了進(jìn)一步探尋治療癌痛更好的手段,所以我們按脊神經(jīng)節(jié)段分布選擇背俞穴位埋線療法在癌痛治療上進(jìn)行探索其作用。目的：本課題將從臨床角度通過(guò)對(duì)癌痛患者在“三階梯止痛方法”基礎(chǔ)上,并結(jié)合脊神經(jīng)節(jié)段分布選擇背俞穴,與單純使用“三階梯止痛方法”進(jìn)行療效的對(duì)比,評(píng)估兩組疼痛緩解的情況以及對(duì)生命質(zhì)量、醫(yī)院焦慮抑郁的影響,為穴位埋線背俞穴治療癌性疼痛提供臨床的依據(jù)。方法：采用隊(duì)列研究的設(shè)計(jì)原則,通過(guò)四個(gè)標(biāo)準(zhǔn)：診斷、納入、排除、脫落標(biāo)準(zhǔn)后,在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院觀察腫瘤中心住院部的60例中、重度癌痛患者。按照患者的意愿分為試驗(yàn)組(30例)及對(duì)照組(30例),對(duì)照組單純以“三階梯止痛方法”給藥,NRS評(píng)分4至6分,屬于中度疼痛,使用藥物為曲馬多緩釋片(100mg/片),1次/片,Q12H；NRS評(píng)分7至10分,屬于重度疼痛,使用藥物為鹽酸羥考酮控釋片(10mg/片),1次/片,Q12H；或者硫酸嗎啡緩釋片(30mg/片),1次/片,Q12H；或者芬太尼透皮貼劑(4.2mg/片),1次／貼,Q72H。若控制不理想,則根據(jù)疼痛緩解的程度予以劑量滴定,直到療效滿意。試驗(yàn)組則在此基礎(chǔ)上,加上按脊神經(jīng)節(jié)段分布選擇背俞穴埋線,每周1次。并予記錄每日的NRS評(píng)分,于治療前及治療后第7天予EORCT-QLQ-C30量表評(píng)價(jià)患者生存質(zhì)量,及醫(yī)院焦慮抑郁量表(HADS量表)來(lái)評(píng)估治療前及治療后第7天癌痛患者客觀疼痛的改變。結(jié)果：分析結(jié)果表明,“試驗(yàn)組”比較“對(duì)照組”,第3天疼痛緩解率具有統(tǒng)計(jì)學(xué)差異(P0.05)。第7天后評(píng)價(jià)兩組生活質(zhì)量,與治療前相比,功能領(lǐng)域中軀體、角色、認(rèn)知、社會(huì)功能及主要癥狀領(lǐng)域中疲倦、疼痛、失眠及食欲的分值都有所提高,具有統(tǒng)計(jì)學(xué)差異(P0.05)。治療后第7天,試驗(yàn)組和對(duì)照組的生活質(zhì)量量表評(píng)分上比較可以看出兩者在主要癥狀領(lǐng)域中,試驗(yàn)組對(duì)于疲倦及失眠的改善方面優(yōu)于對(duì)照組,具有統(tǒng)計(jì)學(xué)差異(P0.05),而剩余比如總健康狀況子量表、功能領(lǐng)域及大部分主要癥狀領(lǐng)域中,并不存在統(tǒng)計(jì)學(xué)差異(P0.05)。治療前后給予HADS自評(píng)量表評(píng)價(jià),本研究表明治療后患者的焦慮抑郁情緒較治療前好轉(zhuǎn),是具有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論：1.以脊神經(jīng)節(jié)段分布選擇背俞穴位埋線聯(lián)合三階梯止痛方法,可以提高有效率,顯示背俞穴位埋線聯(lián)合三階梯組可能比較有優(yōu)勢(shì)。2.以脊神經(jīng)節(jié)段分布選擇背俞穴位埋線可以減少三階梯止痛方法的副作用。3.有效的止痛可以提高患者的生存質(zhì)量。4.癌痛患者多伴有焦慮抑郁狀態(tài),有效的止痛法可以緩解患者的焦慮抑郁狀態(tài)。
[Abstract]:Background: the consciousness of cancer patients with cancer pain, mainly refers to the tumor cell invasion, proliferation, metastasis or oppression caused by the relevant organizations, is the highest incidence of many symptoms. Despite the three step analgesic ladder internationally recognized methods in treating cancer pain, but still failed to control all the pain. The acupoint catgut embedding therapy has the analgesic effect, stimulating effect, without repeated operation advantages. In order to further explore the treatment of cancer pain better means, so we choose according to the spinal ganglion segment distribution of Beishu acupoint catgut embedding therapy to explore its role in the treatment of cancer pain. Objective: this topic will be from a clinical perspective based on cancer patients based on "method" three step, combined with spinal ganglion segment distribution choice Beishu, compared with simply using the method of three step analgesic ladder for efficacy assessment, two groups of pain relief to And the influence on the quality of life, the hospital anxiety and depression, and provide clinical basis for Beishu acupoint catgut embedding for treatment of cancer pain. Methods: a cohort study design principle, through four criteria: diagnosis, inclusion, exclusion, shedding standard, tumor center of inpatient department in the First Affiliated Hospital of Guangzhou University of Chinese Medicine in 60 cases in patients with severe pain. According to the wishes of patients were divided into experimental group (30 cases) and control group (30 cases), the control group were treated with "method" three steps analgesic drug, NRS score of 4 to 6, belonging to moderate pain, the use of drugs for tramadol sustained-release tablets (100mg/ tablet), 1 times / tablet Q12H; NRS score 7 to 10 points, belong to severe pain, the use of drugs for oxycodone hydrochloride controlled-release tablets (10mg/ tablet), 1 /, Q12H; or Morphine Sulfate Sustained-release Tabelets (30mg/), 1 /, Q12H; or Fentany Transdermal System (4.2mg/), 1 / Q72H. if the control stick, Not ideal, according to the degree of pain relief to be dose titration, until satisfactory curative effect. The experimental group on the basis of which, coupled with spinal segment distribution choice Beishu catgut embedding, 1 times a week. And recorded daily NRS score, EORCT-QLQ-C30 scale to evaluate the life quality of the patients in the seventh days before and after treatment to, and the hospital anxiety and Depression Scale (HADS scale) to evaluate the change of seventh days in patients with cancer pain objective pain before and after treatment. Results: the analysis results show that the "experimental group" "control group", the third day pain relief rate was statistically difference (P0.05). Evaluation of quality of life of the two groups of seventh days later, compared with before treatment, the body function in the field of role cognition, fatigue, social function and main symptoms in the field of pain, insomnia and appetite scores are improved, with statistical difference (P0.05). Seventh days after treatment, the test group and the control The quality of life scores on the comparison between them can be found in the main symptoms in the field, the experimental group for fatigue and insomnia improvement than the control group, with statistical difference (P0.05), and the remaining for the overall health status scale, functional areas and most of the main symptoms in the field, there is no statistical difference (P0.05) before and after the treatment. HADS self rating scale evaluation, this study shows that after the treatment of anxiety and depression were better than those before treatment, with statistical difference (P0.05). Conclusion: 1. the spinal ganglion segment distribution choice Beishu acupoint catgut embedding therapy combined with three step method, can improve the efficiency of display, back Shu acupoint catgut embedding therapy combined with the three step group may have side effects.2. selection Beishu acupoint catgut embedding method can reduce the pain by three step spinal ganglion segment distribution of.3. effective analgesia can improve survival The patients with mass.4. cancer pain are mostly associated with anxiety and depression, and effective analgesic method can relieve the state of anxiety and depression.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R730.5

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