癌痛强阿片类药物相关性便秘中医外治法评析
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摘要
强阿片类药物仍然是目前癌痛治疗的一线药,其引起的阿片类药物相关性便秘(Opioid-induced Constipation,OIC)在癌痛患者中十分普遍,严重影响患者的生存质量并有诱发心脑血管事件的风险,因此有效防治OIC有重要临床意义。研究表明,中医外治具有安全、有效、操作方便等特点,对防治OIC有良好前景。针对中医外治法干预癌痛OIC中医病机认识不统一,外治法复杂多样等现象,本文针对以上问题进行归纳并认为:癌痛OIC病机当结合患者证候、阿片类药物药性及二者相互作用综合考虑;外治当综合运用,辨证干预,温通为用;癌痛OIC当视为整体病变的局部反应。相关研究期望为癌痛OIC的中医药优化干预及科学研究提供参考。
Presently,strong opioids are still the first-line drugs for the treatment of cancer pain and Opioid-induced Constipation( OIC)is very common in those patients. OIC significantly affects the quality of life and may induce seriouse cardiovascular and cerebrovascular events,thus,effective prevention and treatment of OIC poses important clinical significance. It has been shown that external treatment by Traditional Chinese Medicine( TCM) is safe,effective,and easy to operate,and has promising prospects for OIC. In view of the inconsistency of TCM syndrome on cancer pain OIC and the complexity,diversity of external treatment method for it,this paper summarizes the above problems and holds the following opinions: a comprehensive consideration of patient syndrome,opioid drug medicinal properties and their interaction on TCM pathogenesis of cancer pain OIC should be taken into account; a comprehensive use of external treatment,dialectical intervention and Wentong principle for OIC should also be implemented and cancer pain OIC should be considered as a local reaction to systemic disease. This article expects to provide reference for optimized TCM intervention and scientific research for cancer pain related OIC.
Presently,strong opioids are still the first-line drugs for the treatment of cancer pain and Opioid-induced Constipation( OIC)is very common in those patients. OIC significantly affects the quality of life and may induce seriouse cardiovascular and cerebrovascular events,thus,effective prevention and treatment of OIC poses important clinical significance. It has been shown that external treatment by Traditional Chinese Medicine( TCM) is safe,effective,and easy to operate,and has promising prospects for OIC. In view of the inconsistency of TCM syndrome on cancer pain OIC and the complexity,diversity of external treatment method for it,this paper summarizes the above problems and holds the following opinions: a comprehensive consideration of patient syndrome,opioid drug medicinal properties and their interaction on TCM pathogenesis of cancer pain OIC should be taken into account; a comprehensive use of external treatment,dialectical intervention and Wentong principle for OIC should also be implemented and cancer pain OIC should be considered as a local reaction to systemic disease. This article expects to provide reference for optimized TCM intervention and scientific research for cancer pain related OIC.
引文
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[14]洪朝金,卢丽琴,钦志泉,等.强阿片类药物治疗癌痛引发便秘的中医证候分布规律的临床研究[J].中国现代医生,2017,55(8):28-30,34.
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[17]Holzer P. Pharmacology of opioids and their effects on gastrointestinal function[J]. Am J GastroenterolSuppl,2014,2(1):9-16.
[18] Matsumoto K,Umemoto H,Mori T,et al. Differences in the morphine-induced inhibition of small and large intestinal transit:Involvement of central and peripheralμ-opioid receptors in mice[J]. Eur J Pharmacol,2016,771:220-228.
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[20]董明会,郭利华.中医治疗吗啡类药物所致便秘的进展[J].云南中医中药杂志,2010,31(3):79-81.
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[22] Browning KN,Travagli RA. Central nervous system control of gastrointestinal motility and secretion and modulation of gastrointestinal functions[J]. Compr Physiol,2014,4(4):1339-1368.
[23] Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gut-enteric microbiota axis[J]. Nat Rev Gastroenterol Hepatol,2009,6(5):306-314.
[24]Wang XM,Li XB,Peng Y. Impact of Qi-invigorating traditional Chinese medicines on intestinal flora:A basis for rational choice of prebiotics[J]. Chin J Nat Med,2017,15(4):241-254.
[25]许钦燕,王国英.电针治疗吗啡所致便秘40例临床观察[J].河北中医,2013,35(12):1845-1846.
[26]蒋益兰,王其美.针刺治疗肿瘤服阿片类镇痛药致便秘患者30例疗效观察[J].中国中医药科技,2010,17(6):544-545.
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[28]张锋利,林洪生,李平,等.电针治疗肺癌患者口服硫酸吗啡控释片所致便秘18例[J].环球中医药,2009,2(3):207-208.
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