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目的通过回顾性研究,评价加巴喷丁联合阿米替林治疗阿片耐受(opioid tolerance)的重度癌痛(cancer pain)的临床疗效。方法以2015年9月至2016年9月间,德阳市人民医院肿瘤科诊断明确的仅能姑息对症治疗的阿片耐受的重度癌痛患者为研究对象。按接受的镇痛治疗方案分为两组,对照组29例:仅给予吗啡(吗啡缓释片、吗啡注射液)治疗;观察组28例:给予加巴喷丁、阿米替林及吗啡(吗啡缓释片、吗啡注射液)治疗。治疗目标为背景痛(background cancer pain)数字评分法(numberical rating scale,NRS)≤3分,两组患者均根据疼痛程度调整药物用量,当出现爆发痛(breakthrough pain,BTP)时采用盐酸吗啡注射液皮下注射。比较两组患者疼痛稳定后焦虑、抑郁、生存质量、日需吗啡量。结果 (1)焦虑、抑郁状态改善:与治疗前相比,两组患者焦虑、抑郁评分均下降(P<0.05),但观察组较对照组下降更明显(P<0.05);(2)日需吗啡量:相比治疗前,疼痛控制稳定需要增加一定量的吗啡,但观察组增加量较对照组少(P<0.05);(3)生存质量:与治疗前相比,两组患者的躯体功能、角色功能及社会功能无明显改变(P>0.05),但情绪功能改善(P<0.05),对照组患者失眠、总健康较治疗前无明显改善(P>0.05),且恶心呕吐、便秘、食欲丧失较治疗前症状加重(P<0.05)。观察组失眠、食欲丧失、总健康得到改善(P<0.05),恶心呕吐、便秘较治疗前无明显变化(P>0.05)。结论加巴喷丁联合阿米替林不仅可增强吗啡对阿片耐受的重度癌痛的疼痛控制,且不增加恶心呕吐、便秘,还可以改善焦虑、抑郁、失眠和食欲丧失等症状,提高总健康评分。
Objective To evaluate the clinical efficacy of gabapentin in combination with amitriptyline in the treatment of severe pain pain caused by opioid tolerance through a retrospective study. Methods From September 2015 to September 2016, Deyang People’s Hospital oncology diagnosed only palliative symptomatic treatment of patients with severe opioid cancer patients for the study. According to the accepted analgesic treatment protocol, the patients were divided into two groups: control group (n = 29): only morphine (morphine sustained-release tablets and morphine injection); observation group: gabapentin, amitriptyline and morphine Tablets, morphine injection) treatment. The target of treatment was background cancer pain with a score of NRS ≤3. Patients in both groups adjusted their dosage according to the degree of pain. When breakthrough pain (BTP) occurred, morphine was injected Subcutaneous injection of liquid. The anxiety, depression, quality of life and daily morphine volume were compared between the two groups after pain was stable. Results (1) Anxiety and depression improved: anxiety and depression scores decreased in both groups (P <0.05) compared with those before treatment (P <0.05); (2) The amount of morphine needed: before treatment, pain control stability need to increase a certain amount of morphine, but the observation group increased less than the control group (P <0.05); (3) quality of life: compared with before treatment, the two groups of patients (P> 0.05), but improved the mood function (P <0.05). The insomnia and total health of the control group had no significant improvement (P> 0.05), and nausea and vomiting, Constipation, loss of appetite worse than before treatment (P <0.05). Observation group insomnia, loss of appetite, total health was improved (P <0.05), nausea and vomiting, constipation than before treatment no significant change (P> 0.05). Conclusion Gabapentin combined with amitriptyline can not only enhance the pain control of morphine against opioid-bearing severe pain without increasing nausea, vomiting and constipation, but also improve symptoms such as anxiety, depression, insomnia and loss of appetite and improve the overall health score.