奥氮平联合盐酸羟考酮对晚期肝癌疼痛患者的作用探讨
|
摘要
目的探讨晚期肝癌疼痛患者应用奥氮平联合盐酸羟考酮的止痛作用,并分析其疼痛应激、心理状态变化。方法选择我院收治的84例晚期肝癌疼痛患者为研究对象,按照随机数字表法分为常规组与联合组,均行mFOLFOX6化疗。常规组采用盐酸羟考酮进行止痛,联合组采用奥氮平联合盐酸羟考酮进行止痛。对比治疗前、治疗3 d、1周、2周后数字模拟疼痛量表(NRS)评分的变化,治疗前后疼痛应激相关血清指标及心理状态的变化,治疗期间平均爆发痛次数、平均睡眠时间及安全性。结果 NRS评分不同时间点、组间和交互作用对比,差异均有统计学意义(P<0.05);治疗后两组NRS评分均呈时间依赖性(P<0.05),且治疗1周、2周后联合组NRS评分均显著低于常规组(P<0.05);治疗后两组血清5-羟色胺(5-HT)、神经肽Y(NPY)、前列腺素E_2(PGE_2)水平均明显降低(P<0.05),且联合组显著低于常规组(P<0.05);治疗后两组焦虑、抑郁评分均明显降低(P<0.05),且联合组显著低于常规组(P<0.05);联合组治疗期间平均爆发痛次数明显少于常规组(P<0.05),平均睡眠时间明显长于常规组(P<0.05);联合组不良反应发生率与常规组相近,差异无统计学意义(P>0.05)。结论对晚期肝癌疼痛患者mFOLFOX化疗期间采用奥氮平联合盐酸羟考酮治疗具有理想的止痛作用,能够改善疼痛应激相关血清指标和心理状态,减少爆发痛,延长睡眠时间,且不会明显增加不良反应。
Objective To investigate analgesic effects of olanzapine combined with oxycodone hydrochloride on patients with advanced hepatocellular carcinoma, and to analyze the changes of pain stress and psychological states. Methods Eighty-four patients with pain in advanced hepatocellular carcinoma were divided into routine group and combined group by a random number table. They were all given m FOLFOX6 chemotherapy. The routine group was treated with oxycodone hydrochloride, while the combined group was treated with olanzapine combined with oxycodone hydrochloride. The changes of pain numeric rating scale(NRS) scores were compared before treatment,after 3 d, 1 week and 2 weeks of treatment. The changes of pain degrees, serum pain stress related index levels and psychological states before and after treatment, average times of pain-outbreaks, average sleeping time and safety during treatment were compared between the two groups. Results There were significant differences in NRS scores between moments, groups and interaction(P<0.05). After treatment, the NRS scores showed a time-dependence in both groups(P<0.05), and they were lower in the combined group than in the routine group after1 week and 2 weeks of treatment(P<0.05). The serum levels of 5-HT, NPY and PGE_2 in the two groups were all decreased after treatment(P<0.05), and they were lower in the combined group than in the routine group(P<0.05). After treatment, the scores of anxiety and depression were decreased in both groups(P<0.05), and the scores in the combined group were lower than in the routine group(P<0.05). The average times of pain-outbreaks in the combined group was significantly less than in the routine group(P<0.05). In addition, patients in the combined group had averagely longer sleep time than those in the routine group(P<0.05). The incidence of adverse reactions in the combined group was similar to that in the routine group, without statistically significant difference(P>0.05). Conclusion Olanzapine combined with oxycodone hydrochloride has a good analgesic effect on patients with pain in advanced hepatocellular carcinoma. It can improve the serum indexes related to pain stress and psychological state, reduce the outbreaks of pain and prolong sleeping time, yet without significant increase of adverse reactions.
Objective To investigate analgesic effects of olanzapine combined with oxycodone hydrochloride on patients with advanced hepatocellular carcinoma, and to analyze the changes of pain stress and psychological states. Methods Eighty-four patients with pain in advanced hepatocellular carcinoma were divided into routine group and combined group by a random number table. They were all given m FOLFOX6 chemotherapy. The routine group was treated with oxycodone hydrochloride, while the combined group was treated with olanzapine combined with oxycodone hydrochloride. The changes of pain numeric rating scale(NRS) scores were compared before treatment,after 3 d, 1 week and 2 weeks of treatment. The changes of pain degrees, serum pain stress related index levels and psychological states before and after treatment, average times of pain-outbreaks, average sleeping time and safety during treatment were compared between the two groups. Results There were significant differences in NRS scores between moments, groups and interaction(P<0.05). After treatment, the NRS scores showed a time-dependence in both groups(P<0.05), and they were lower in the combined group than in the routine group after1 week and 2 weeks of treatment(P<0.05). The serum levels of 5-HT, NPY and PGE_2 in the two groups were all decreased after treatment(P<0.05), and they were lower in the combined group than in the routine group(P<0.05). After treatment, the scores of anxiety and depression were decreased in both groups(P<0.05), and the scores in the combined group were lower than in the routine group(P<0.05). The average times of pain-outbreaks in the combined group was significantly less than in the routine group(P<0.05). In addition, patients in the combined group had averagely longer sleep time than those in the routine group(P<0.05). The incidence of adverse reactions in the combined group was similar to that in the routine group, without statistically significant difference(P>0.05). Conclusion Olanzapine combined with oxycodone hydrochloride has a good analgesic effect on patients with pain in advanced hepatocellular carcinoma. It can improve the serum indexes related to pain stress and psychological state, reduce the outbreaks of pain and prolong sleeping time, yet without significant increase of adverse reactions.
引文
[1]Mercadante S, Marchetti P, Cuomo A, et al. Breakthrough Cancer Pain:Preliminary Data of The Italian Oncologic Pain Multisetting Multicentric Survey(IOPS-MS)[J]. Adv Ther,2017, 34(1):120-135. doi:10.1007/s12325-016-0440-4.
[2]Mercadante S, Portenoy RK. Breakthrough cancer pain:twenty-five years of study[J]. Pain, 2016, 157(12):2657-2663. doi:10.1097/j. pain.0000000000000721.
[3]Guo KK, Deng CQ, Lu GJ, et al. Correction to:Comparison of analgesic effect of oxycodone and morphine on patients with moderate and advanced cancer pain:a meta-analysis[J]. BMC Anesthesiol, 2018, 18(1):173. doi:10.1186/s12871-018-0630-5.
[4]彭雷,戚焕鹏,翟西菊.奥氮平辅助治疗肺癌骨转移重度疼痛及相关性焦虑、抑郁的临床观察[J].肿瘤基础与临床,2017, 30(1):46-48. doi:10.3969/j. issn.1673-5412.2017.01.012.
[5]汤钊猷.现代肿瘤学[M].上海:复旦大学出版社, 2011:206-211.
[6]胡夕春,王杰军,常建华,等.癌症疼痛诊疗上海专家共识(2017年版)[J].中国癌症杂志, 2017, 27(4):312-320.doi:10.19401/j. cnki.1007-3639.2017.04.012.
[7]Goulet J, Carroll C, Buta E, et al.(143)Variation in pain NRS screening scores by patient and facility characteristics in a national system of care[J]. Journal of Pain, 2015, 16(4):S11-S11. doi:10.1016/j. jpain.2015.01.057.
[8]Samakouri M, Bouhos G, Kadoglou M, et al. Standardization of the Greek version of Zung's Self-rating Anxiety Scale(SAS)[J]. Psychiatriki, 2012, 23(3):212-220.
[9]Hunter EE, Murphy M. Zung Self-Rating Depression Scale[J]. Encyclopedia of Clinical Neuropsychology, 2011, 36(4):2746-2747. doi:10.1007/978-0-387-79948-3_2017.
[10]Hingorani SR, Harris WP, Beck JT, et al. Phase Ib Study of PEGylated Recombinant Human Hyaluronidase and Gemcitabine in Patients with Advanced Pancreatic Cancer[J]. Clin Cancer Res, 2016, 22(12):2848-2854. doi:10.1158/1078-0432. CCR-15-2010.
[11]Sexton J, Atayee RS, Bruner HC. Case Report:Ketamine for Pain and Depression in Advanced Cancer[J]. J Palliat Med,2018, 21(11):1670-1673. doi:10.1089/jpm.2017.0551.
[12]俞南南,钟泰迪.盐酸氢吗啡酮对晚期乳腺癌患者的镇痛效果及疼痛相关激素水平研究[J].浙江医学, 2018,40(8):839-842. doi:CNKI:SUN:ZJYE.0.2018-08-015.
[13]Guo KK, Deng CQ, Lu GJ, et al. Comparison of analgesic effect of oxycodone and morphine on patients with moderate and advanced cancer pain:a meta-analysis[J]. BMC Anesthesiol, 2018,18(1):173. doi:https://doi. org/10.1186/s12871-018-0630-5.
[14]程海波,吴勉华,沈卫星,等.基于癌毒病机理论的癌痛平胶囊治疗癌性疼痛的研究[J].中华中医药杂志,2015, 30(12):4371-4374.
[15]程蕾,涂小磊.超声引导下胸椎旁阻滞联合全身麻醉对乳腺癌改良根治术后疼痛相关介质分泌的影响[J].海南医学院学报, 2018, 24(1):45-48. doi:10.13210/j. cnki.jhmu.20171222.001.
[16]Sugita R, Kuwabara H, Kubota K, et al. Simultaneous Inhibition of PGE2 and PGI2 Signals Is Necessary to Suppress Hyperalgesia in Rat Inflammatory Pain Models[J]. Mediators Inflamm, 2016, 2016:9847840. doi:10.1155/2016/9847840.
[17]杜亚青.活络效灵丹辨证辅助治疗对中重度癌性疼痛的镇痛效应研究[J].重庆医学, 2017, 46(10):1404-1407.doi:CNKI:SUN:CQYX.0.2017-10-040.
[18]刘艳丽,徐凯智.盐酸羟考酮对腹腔镜胆囊切除患者术后P物质、5-HT的影响[J].华北理工大学学报(医学版),2016, 18(4):303-307.
[19]Inoue S, Saito Y, Tsuneto S, et al. A randomized, doubleblind study of hydromorphone hydrochloride extended-release tablets versus oxycodone hydrochloride extended-release tablets for cancer pain:efficacy and safety in Japanese cancer patients(EXHEAL:a Phase III study of EXtendedrelease HydromorphonE for cAncer pain reLief)[J]. J Pain Res, 2017, 18(10):1953-1962.
[20]Passik SD, Navari RM, Jung SH, et al. A phase I trial of olanzapine(Zyprexa)for the prevention of delayed emesis in cancer patients:a Hoosier Oncology Group study[J]. Cancer Invest, 2004, 22(3):383-388. doi:10.1081/CNV-200029066.
[2]Mercadante S, Portenoy RK. Breakthrough cancer pain:twenty-five years of study[J]. Pain, 2016, 157(12):2657-2663. doi:10.1097/j. pain.0000000000000721.
[3]Guo KK, Deng CQ, Lu GJ, et al. Correction to:Comparison of analgesic effect of oxycodone and morphine on patients with moderate and advanced cancer pain:a meta-analysis[J]. BMC Anesthesiol, 2018, 18(1):173. doi:10.1186/s12871-018-0630-5.
[4]彭雷,戚焕鹏,翟西菊.奥氮平辅助治疗肺癌骨转移重度疼痛及相关性焦虑、抑郁的临床观察[J].肿瘤基础与临床,2017, 30(1):46-48. doi:10.3969/j. issn.1673-5412.2017.01.012.
[5]汤钊猷.现代肿瘤学[M].上海:复旦大学出版社, 2011:206-211.
[6]胡夕春,王杰军,常建华,等.癌症疼痛诊疗上海专家共识(2017年版)[J].中国癌症杂志, 2017, 27(4):312-320.doi:10.19401/j. cnki.1007-3639.2017.04.012.
[7]Goulet J, Carroll C, Buta E, et al.(143)Variation in pain NRS screening scores by patient and facility characteristics in a national system of care[J]. Journal of Pain, 2015, 16(4):S11-S11. doi:10.1016/j. jpain.2015.01.057.
[8]Samakouri M, Bouhos G, Kadoglou M, et al. Standardization of the Greek version of Zung's Self-rating Anxiety Scale(SAS)[J]. Psychiatriki, 2012, 23(3):212-220.
[9]Hunter EE, Murphy M. Zung Self-Rating Depression Scale[J]. Encyclopedia of Clinical Neuropsychology, 2011, 36(4):2746-2747. doi:10.1007/978-0-387-79948-3_2017.
[10]Hingorani SR, Harris WP, Beck JT, et al. Phase Ib Study of PEGylated Recombinant Human Hyaluronidase and Gemcitabine in Patients with Advanced Pancreatic Cancer[J]. Clin Cancer Res, 2016, 22(12):2848-2854. doi:10.1158/1078-0432. CCR-15-2010.
[11]Sexton J, Atayee RS, Bruner HC. Case Report:Ketamine for Pain and Depression in Advanced Cancer[J]. J Palliat Med,2018, 21(11):1670-1673. doi:10.1089/jpm.2017.0551.
[12]俞南南,钟泰迪.盐酸氢吗啡酮对晚期乳腺癌患者的镇痛效果及疼痛相关激素水平研究[J].浙江医学, 2018,40(8):839-842. doi:CNKI:SUN:ZJYE.0.2018-08-015.
[13]Guo KK, Deng CQ, Lu GJ, et al. Comparison of analgesic effect of oxycodone and morphine on patients with moderate and advanced cancer pain:a meta-analysis[J]. BMC Anesthesiol, 2018,18(1):173. doi:https://doi. org/10.1186/s12871-018-0630-5.
[14]程海波,吴勉华,沈卫星,等.基于癌毒病机理论的癌痛平胶囊治疗癌性疼痛的研究[J].中华中医药杂志,2015, 30(12):4371-4374.
[15]程蕾,涂小磊.超声引导下胸椎旁阻滞联合全身麻醉对乳腺癌改良根治术后疼痛相关介质分泌的影响[J].海南医学院学报, 2018, 24(1):45-48. doi:10.13210/j. cnki.jhmu.20171222.001.
[16]Sugita R, Kuwabara H, Kubota K, et al. Simultaneous Inhibition of PGE2 and PGI2 Signals Is Necessary to Suppress Hyperalgesia in Rat Inflammatory Pain Models[J]. Mediators Inflamm, 2016, 2016:9847840. doi:10.1155/2016/9847840.
[17]杜亚青.活络效灵丹辨证辅助治疗对中重度癌性疼痛的镇痛效应研究[J].重庆医学, 2017, 46(10):1404-1407.doi:CNKI:SUN:CQYX.0.2017-10-040.
[18]刘艳丽,徐凯智.盐酸羟考酮对腹腔镜胆囊切除患者术后P物质、5-HT的影响[J].华北理工大学学报(医学版),2016, 18(4):303-307.
[19]Inoue S, Saito Y, Tsuneto S, et al. A randomized, doubleblind study of hydromorphone hydrochloride extended-release tablets versus oxycodone hydrochloride extended-release tablets for cancer pain:efficacy and safety in Japanese cancer patients(EXHEAL:a Phase III study of EXtendedrelease HydromorphonE for cAncer pain reLief)[J]. J Pain Res, 2017, 18(10):1953-1962.
[20]Passik SD, Navari RM, Jung SH, et al. A phase I trial of olanzapine(Zyprexa)for the prevention of delayed emesis in cancer patients:a Hoosier Oncology Group study[J]. Cancer Invest, 2004, 22(3):383-388. doi:10.1081/CNV-200029066.