抗抑郁药物联合阿片类药物和心理干预治疗晚期癌痛伴抑郁的疗效观察

目的研究抗抑郁药物作为辅助性干预措施对伴有抑郁状态和癌痛晚期癌症患者的治疗效果。方法将68例患者随机分为两组,进行为期4周的临床观察。对照组联合使用阿片类药物以及心理干预,治疗组联合使用阿片类药物、心理干预以及抗抑郁药物度洛西汀,采用汉密尔顿抑郁量表(HAMD17)、视觉模拟评分法(VAS)于治疗前及治疗后第1、2、4周末进行疗效评估,观察辅助性抗抑郁药物对伴有抑郁状态的癌痛患者抑郁情绪及联合用药对疼痛改善、阿片类药物使用的情况。结果在治疗后第1、2、4周末,治疗组患者HAMD17评分显著降低,抑郁情绪明显改善(P<0.05),对照组患者治疗前后HAMD17评分无明显下降(P>0.05)。治疗组患者在治疗后第2、4周末HAMD17焦虑/躯体化、体重、认知障碍、睡眠障碍以及阻滞各因子分均有显著下降(P<0.05)。治疗组患者阿片类药物使用量在治疗前后无明显增加(P>0.05),而对照组患者阿片类药物使用量在第4周末有显著增加(P<0.05)。治疗组患者在用药期间未见明显的不良反应。结论对伴有抑郁状态的晚期癌痛患者,单纯的心理干预和止痛治疗不能明显改善患者抑郁情绪;在接受阿片类药物和心理干预的同时联合抗抑郁药物度洛西汀,其效果优于阿片类药物联合心理干预,能明显缓解患者抑郁情绪,并有益于疼痛的控制。

Efficacy of antidepressant drugs combined opioid and psychological interventions for treatment of advanced cancer pain with depression

Objective To evaluate antidepressant drugs as adjuvant interventions associated with depression and treatment of patients with advanced cancer pain. Methods Using HAMD17 （ Hamilton Depression Rating Scale）, VAS （visual analogue scale）, 68 patients were randomly divided into two groups, conducted a four-week clinical study. The control group was Joint use of opioids and psychological intervention. Treatment groups was combined use of opioids, psychological intervention and antidepressant duloxetine. Efficacy assessed before treatment and at week 1,2,4 after treatment to observe auxiliary antidepressants for depression in patients with pain associated with depression and combination therapy for pain relief. Results HAMD17 score of treatment groups was significantly lower and depression was improved significantly at week 1,2,4, but the amount of opioid was no significantly increased after treatment （ P 〈 0. 05 ）. In contrast the results of the control group（ P 〉 0. 05 ） and the amount of opioid was significantly increased（ P 〈 0. 05 ）. Patients in the treatment group after treatment week 2,4 HAMD17 anxiety / somatization, weight, cognitive disorders, sleep disorders and retardation factor scores were significantly lower（ P 〈 0. 05 ）. Treated patients during treatment showed no adverse reactions. Conclusion Advanced cancer patients with simple psychological intervention and treatment of pain associated with depression could not be significantly im- proved in patients with depression. The efficacy of Opioids and psychological interventions combined with antidepressant medication duloxetine was better than opioids combined with psychological intervention.