發(fā)布時間：2018-07-13 09:59

【摘要】：目的通過回顧性研究,評價加巴噴丁聯(lián)合阿米替林治療阿片耐受(opioid tolerance)的重度癌痛(cancer pain)的臨床療效。方法以2015年9月至2016年9月間,德陽市人民醫(yī)院腫瘤科診斷明確的僅能姑息對癥治療的阿片耐受的重度癌痛患者為研究對象。按接受的鎮(zhèn)痛治療方案分為兩組,對照組29例:僅給予嗎啡(嗎啡緩釋片、嗎啡注射液)治療;觀察組28例:給予加巴噴丁、阿米替林及嗎啡(嗎啡緩釋片、嗎啡注射液)治療。治療目標為背景痛(background cancer pain)數(shù)字評分法(numberical rating scale,NRS)≤3分,兩組患者均根據(jù)疼痛程度調整藥物用量,當出現(xiàn)爆發(fā)痛(breakthrough pain,BTP)時采用鹽酸嗎啡注射液皮下注射。比較兩組患者疼痛穩(wěn)定后焦慮、抑郁、生存質量、日需嗎啡量。結果 (1)焦慮、抑郁狀態(tài)改善:與治療前相比,兩組患者焦慮、抑郁評分均下降(P0.05),但觀察組較對照組下降更明顯(P0.05);(2)日需嗎啡量:相比治療前,疼痛控制穩(wěn)定需要增加一定量的嗎啡,但觀察組增加量較對照組少(P0.05);(3)生存質量:與治療前相比,兩組患者的軀體功能、角色功能及社會功能無明顯改變(P0.05),但情緒功能改善(P0.05),對照組患者失眠、總健康較治療前無明顯改善(P0.05),且惡心嘔吐、便秘、食欲喪失較治療前癥狀加重(P0.05)。觀察組失眠、食欲喪失、總健康得到改善(P0.05),惡心嘔吐、便秘較治療前無明顯變化(P0.05)。結論加巴噴丁聯(lián)合阿米替林不僅可增強嗎啡對阿片耐受的重度癌痛的疼痛控制,且不增加惡心嘔吐、便秘,還可以改善焦慮、抑郁、失眠和食欲喪失等癥狀,提高總健康評分。
[Abstract]:Objective to evaluate the clinical efficacy of gabapentin combined with amitriptyline in the treatment of severe cancerous (cancer pain) with opioid tolerance to (opioid tolerance). Methods from September 2015 to September 2016, the patients with severe opioid tolerance in Department of Oncology, Deyang people's Hospital, who could only be treated with palliative treatment, were studied. The control group (29 cases) received morphine (morphine sustained-release tablets, morphine injection) and the observation group (28 cases) received gabapentin, amitriptyline and morphine (morphine sustained-release tablets). Morphine injection) treatment. The target of treatment was (numberical rating scale-NRS 鈮，

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