中医药治疗阿片类药物所致便秘新进展
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摘要
便秘是晚期癌痛病人服用阿片类药物最常见的并发症,发生率高达90%～100%,不仅出现在用药早期,而且贯穿整个治疗过程。临床主要表现为腹胀、便量减少、排便不尽感及里急后重,甚至引起恶心呕吐、呼吸困难、情绪异常、焦虑、抑郁等,严重干扰患者生活,增加癌痛患者额外痛苦。中医药治疗阿片类药物所致便秘(Opioid-induced constipation,OIC)方法多样,疗效肯定,优势显著,近年来涌现了较多的临床报道和研究。现就OIC的病因病机及治疗方法作简要综述。
As the most common complication of patients with advanced cancer pain after the administration of opioids,constipation occurs in the early stage of medication and throughout the whole treatment process,of which the incidence is up to 90% to 100%. The main clinical manifestations include abdominal distention,reduce in defecation amount,sense of incomplete defecation and tenesmus,even leading to nausea and vomiting,dyspnea,emotional disorder,anxiety and depression,which seriously disturb the life of patients and result in extra pain of patients with advanced cancer pain. Opioid-induced constipation is treated with Chinese medicine,added to which the methods are various,the clinical effect is definite and the advantages are significant. In this way,numerous clinical reports and researches spring up in recent years. The etiology and pathogenesis of OIC as well as its treatment will be briefly reviewed in the passage.
As the most common complication of patients with advanced cancer pain after the administration of opioids,constipation occurs in the early stage of medication and throughout the whole treatment process,of which the incidence is up to 90% to 100%. The main clinical manifestations include abdominal distention,reduce in defecation amount,sense of incomplete defecation and tenesmus,even leading to nausea and vomiting,dyspnea,emotional disorder,anxiety and depression,which seriously disturb the life of patients and result in extra pain of patients with advanced cancer pain. Opioid-induced constipation is treated with Chinese medicine,added to which the methods are various,the clinical effect is definite and the advantages are significant. In this way,numerous clinical reports and researches spring up in recent years. The etiology and pathogenesis of OIC as well as its treatment will be briefly reviewed in the passage.
引文
[1]Zhu XC,Zhang JL,Ge CT,et al.Advances in cancer pain from bone metastasis[J].Drug Des Devel Ther,2015(9):4239-4245.
[2]Cook SF,Lanza L,Zhou X,et al.Gastrointestinal side effects in Chronic opioid users:results from a population-based survey[J].Aliment Pharmacol Ther,2008,27(12):1224.
[3]符丹丽,陈培丰.中医药治疗阿片类药物相关性便秘研究进展[J].浙江中西医结合杂志,2018,28(1):75-76.
[4]关洁珊,林丽珠,高海利,等.小承气汤合增液汤治疗阿片类止痛药所致便秘50例临床研究[J].江苏中医药,2014,46(2):35-36.
[5]附舰,闵婕,杨雪,等.润肠通便方治疗阿片类相关便秘36例[J].陕西中医,2013,34(5):537-538.
[6]赵常国,刘颖,石颖,等.加味济川煎治疗阿片性便秘(阳虚型)45例临床观察[J].云南中医中药杂志,2016,37(5):29-30.
[7]王愿达.麦门冬汤合增液承气汤加味“肺肠同治”治疗阿片类药物所致阴虚便秘的临床研究[D].昆明:云南中医学院,2017.
[8]张俊萍,田菲.新加黄龙汤治疗阿片类药所致便秘的临床观察[C]//中国中西医结合学会肿瘤专业委员会.第三届国际中医、中西医结合肿瘤学术交流大会暨第十二届全国中西医结合肿瘤学术大会论文汇编.宁波:[出版者不详],2010:3.
[9]徐丰改.加味枳术汤干预长期服用阿片类止痛药物治疗癌痛引起的便秘的疗效观察[D].泸州:泸州医学院,2014.
[10]王煜坤.扶正润肠汤治疗阿片类药物性便秘疗效观察[J].世界中西医结合杂志,2017,12(6):811-817.
[11]郭延东,胡晓燕,李林,等.芍黄通便合剂治疗阿片类药物所致气滞型便秘的疗效观察[J].西部医学,2017,29(3):399-402.
[12]候淑芳,谢洁芸,林锦秀.加味麻子仁汤治疗阿片类药物所致便秘的临床研究[J].云南中医学院学报,2017,40(1):41-43,47.
[13]邓海燕,陈信义,刘丹,等.中药穴位贴敷神阙穴治疗阿片类药物所致便秘的临床观察[J].中国医刊,2016,51(7):110-112.
[14]王瑶,张书生.通便散穴位贴敷治疗阿片类药物所致便秘的疗效观察[J].中医临床研究,2017,9(19):50-51.
[15]梁超,邓海燕,郑丽平,等.中药敷脐治疗阿片类相关性便秘的临床观察[J].中国临床医生杂志,2017,45(7):119-121.
[16]蔡娇芝,赵莞丽.大黄粉神阙贴敷联合按压天枢防治阿片类药物不良反应便秘效果观察[J].新中医,2015,47(3):260-261.
[17]夏超.提肛运动配合中药穴位贴敷治疗阿片类药物所致便秘的疗效观察[J].全科护理,2015,13(35):3598-3599.
[18]徐海燕,杨红.针灸治疗阿片类药物性便秘疗效观察[J].检验医学与临床,2013,10(8):985-986.
[19]刘田田.穴位埋线防治阿片类药物所致便秘的临床观察[D].合肥:安徽中医药大学,2017.
[20]严妍,程园园,任晓琴.艾灸对癌痛患者阿片类药物镇痛致便秘的疗效观察[J].中医药临床杂志,2014,26(8):785-786.
[21]张传霞,任鲁颖.中药灌肠法治疗阿片性便秘的临床观察[J].光明中医,2014,29(12):2580-2581.
[22]李晨,金昌凤,刘玉明.涤肠汤灌肠治疗阿片类药物所致便秘疗效观察[J].实用中医药杂志,2014,30(1):10.
[23]郭丽.中药口服配合穴位贴敷治疗药物性便秘60例疗效观察[J].基层医学论坛,2017,21(19):2557-2558.
[24]周冬冬.从气论治针药结合治疗阿片类药物所致便秘的临床研究[D].昆明:云南中医学院,2016.
[25]钟斯婷,劳敏莹.六磨汤配合艾灸治疗阿片类药物所致便秘临床研究[J].新中医,2016,48(4):59-60.
[2]Cook SF,Lanza L,Zhou X,et al.Gastrointestinal side effects in Chronic opioid users:results from a population-based survey[J].Aliment Pharmacol Ther,2008,27(12):1224.
[3]符丹丽,陈培丰.中医药治疗阿片类药物相关性便秘研究进展[J].浙江中西医结合杂志,2018,28(1):75-76.
[4]关洁珊,林丽珠,高海利,等.小承气汤合增液汤治疗阿片类止痛药所致便秘50例临床研究[J].江苏中医药,2014,46(2):35-36.
[5]附舰,闵婕,杨雪,等.润肠通便方治疗阿片类相关便秘36例[J].陕西中医,2013,34(5):537-538.
[6]赵常国,刘颖,石颖,等.加味济川煎治疗阿片性便秘(阳虚型)45例临床观察[J].云南中医中药杂志,2016,37(5):29-30.
[7]王愿达.麦门冬汤合增液承气汤加味“肺肠同治”治疗阿片类药物所致阴虚便秘的临床研究[D].昆明:云南中医学院,2017.
[8]张俊萍,田菲.新加黄龙汤治疗阿片类药所致便秘的临床观察[C]//中国中西医结合学会肿瘤专业委员会.第三届国际中医、中西医结合肿瘤学术交流大会暨第十二届全国中西医结合肿瘤学术大会论文汇编.宁波:[出版者不详],2010:3.
[9]徐丰改.加味枳术汤干预长期服用阿片类止痛药物治疗癌痛引起的便秘的疗效观察[D].泸州:泸州医学院,2014.
[10]王煜坤.扶正润肠汤治疗阿片类药物性便秘疗效观察[J].世界中西医结合杂志,2017,12(6):811-817.
[11]郭延东,胡晓燕,李林,等.芍黄通便合剂治疗阿片类药物所致气滞型便秘的疗效观察[J].西部医学,2017,29(3):399-402.
[12]候淑芳,谢洁芸,林锦秀.加味麻子仁汤治疗阿片类药物所致便秘的临床研究[J].云南中医学院学报,2017,40(1):41-43,47.
[13]邓海燕,陈信义,刘丹,等.中药穴位贴敷神阙穴治疗阿片类药物所致便秘的临床观察[J].中国医刊,2016,51(7):110-112.
[14]王瑶,张书生.通便散穴位贴敷治疗阿片类药物所致便秘的疗效观察[J].中医临床研究,2017,9(19):50-51.
[15]梁超,邓海燕,郑丽平,等.中药敷脐治疗阿片类相关性便秘的临床观察[J].中国临床医生杂志,2017,45(7):119-121.
[16]蔡娇芝,赵莞丽.大黄粉神阙贴敷联合按压天枢防治阿片类药物不良反应便秘效果观察[J].新中医,2015,47(3):260-261.
[17]夏超.提肛运动配合中药穴位贴敷治疗阿片类药物所致便秘的疗效观察[J].全科护理,2015,13(35):3598-3599.
[18]徐海燕,杨红.针灸治疗阿片类药物性便秘疗效观察[J].检验医学与临床,2013,10(8):985-986.
[19]刘田田.穴位埋线防治阿片类药物所致便秘的临床观察[D].合肥:安徽中医药大学,2017.
[20]严妍,程园园,任晓琴.艾灸对癌痛患者阿片类药物镇痛致便秘的疗效观察[J].中医药临床杂志,2014,26(8):785-786.
[21]张传霞,任鲁颖.中药灌肠法治疗阿片性便秘的临床观察[J].光明中医,2014,29(12):2580-2581.
[22]李晨,金昌凤,刘玉明.涤肠汤灌肠治疗阿片类药物所致便秘疗效观察[J].实用中医药杂志,2014,30(1):10.
[23]郭丽.中药口服配合穴位贴敷治疗药物性便秘60例疗效观察[J].基层医学论坛,2017,21(19):2557-2558.
[24]周冬冬.从气论治针药结合治疗阿片类药物所致便秘的临床研究[D].昆明:云南中医学院,2016.
[25]钟斯婷,劳敏莹.六磨汤配合艾灸治疗阿片类药物所致便秘临床研究[J].新中医,2016,48(4):59-60.