镇痛散结膏对癌症的镇痛效果

我院于1993～1994年应用自制的镇痛散结膏治疗中重度癌痛患者44例,同时与杜冷丁止痛作用对比观察。 临床资料:肝癌18例,胰腺癌、胃癌各5例,结肠癌4例,食管癌3例,骨转移癌8例,颅转移癌1例。 方法:全组病例均先用镇痛散结膏贴神阙、期门穴各1贴,24小时后改贴神阙、肝俞穴各1贴。本组中29例在应用镇痛散结膏48小时后,改用杜冷丁止痛。与镇痛散结膏的止痛效果作自身对比观察。 结果:①镇痛疗效评价:无效(NP):疼痛程度未见缓解。轻度缓解(MR):治疗后疼痛仅稍有减轻,但仍有明显疼痛,要求镇痛治疗。明显缓解(AR):疼痛明显减轻可以忍受,但仍有轻度疼痛。完全缓解(RR):疼痛完全消失。显著有效为AR+CR。②镇痛起效、镇痛时间和镇痛效果:详见表1、2。     

激光、微波和宫颈炎康栓局部治疗宫颈糜烂疗效对比观察

目的对比观察激光、微波和宫颈炎康栓局部治疗宫颈糜烂的临床疗效。方法将180例宫颈糜烂患者随机分为A、B、C组各60例,分别采用激光、微波局部照射和宫颈炎康栓阴道给药治疗。结果 A组治愈7例,显效26例,有效17例,无效10例,总有效率为83.33%,A组中轻度患者分别为7、7、6、2例及90.91%,中度患者分别为0、10、5、4例及78.95%,重度患者分别为0、9、6、4例及78.95%;B组分别为14、20、20、6例和,B组90.00%,其中轻度患者分别为10、4、6、1例及95.24%,中度患者分别为4、6、8、2例及90.00%,重度患者分别为0、10、6、3例及84.21%;C组分别为8、24、18、10例和83.33%,C组中轻度患者分别为7、6、6、2例及90.48%,中度患者分别为1、9、6、4例及80.00%,重度患者分别为0、9、6、4例及78.95%。三组治疗总有效率及轻度患者治疗有效率比较,P均〉0.05。B组中、重度患者有效率与A、C组比较,P均〈0.05。结论激光、微波和宫颈炎康栓局部治疗宫颈糜烂均有效,对轻度患者可采用药物治疗,对中重度患者可采用激光、微波治疗。     

不同分割放射治疗恶性肿瘤骨转移68例疗效观察

目的探讨不同分割放射治疗恶性肿瘤骨转移对疼痛和体力状况的影响。方法对68例恶性肿瘤骨转移住院患者应用6 MV X线,采用三种不同的剂量分割照射：常规分割（40 Gy/20次/28 d）、加速分割（30 Gy/10次/14 d）、低分割（20～30 Gy/4～6次/12 d）。评价治疗结束后止痛效果和治疗2周体力状况ECOG改善情况。结果常规分割、加速分割与低分割三种不同的模式照射对止痛的总有效率为90.1%、96.4%8、8.9%。三种模式对ECOG评分改善的总有效率为90.1%8、5.7%8、3.3%;三种模式间比较止痛和ECOG评分改善差异无统计学意义（P〉0.05）。结论常规分割、加速分割与低分割三种模式对骨转移癌疼痛的止痛和ECOG评分改善相似。如无特殊要求,加速分割照射由于照射疗程短、能减轻患者经济负担,可作为首选。     

放疗联合伊班膦酸钠对骨转移癌的止痛疗效

目的观察放疗联合伊班膦酸钠治疗对骨转移癌的止痛疗效。方法将130例骨转移癌患者随机分成单放组66例和联合组64例。两组均行6 MV-X线照射治疗,2～3 Gy/次,靶区剂量35～50 Gy;联合组在放疗前1、27 d静滴伊班膦酸钠4 mg,以后每4周重复,共2～5次。结果联合组总有效率为98.48%,单放组为87.50%,两组比较P<0.05;与单放组比较,联合组疼痛缓解起效时间明显缩短,疼痛缓解持续时间明显延长(P<0.01或<0.05)。结论放疗联合伊班膦酸钠能有效、更快地缓解骨转移癌患者的疼痛症状,延长其疼痛缓解持续时间。     

降钙素治疗骨转移瘤性疼痛及高钙血症(附40例报告)

对40例骨转移瘤患者给予降钙素100 IU肌注,1次/d,15 d为1疗程。比较患者治疗前后疼痛程度,离子选择电极法测定治疗前后患者血钙水平。结果用降钙素治疗1疗程24例,2疗程12例,3疗程4例;疼痛完全缓解6例,部分缓解27例,轻度缓解4例,无效3例,止痛有效率为82.5%（33/40）;治疗后血清钙含量较治疗前下降77.5%。认为降钙素可能明显缓解中、晚期骨转移瘤造成的疼痛,预防并减少骨相关事件的发生。     

其他

20012915魏施康定治疗晚期癌症疼痛疗效观察/高中度…/陕西医学杂志一2001,30(1)一14~15 81例患者用药分两种情况:未服用过阿片药物者,起始剂盘10 mg/次,每日2次;服用过阿片类药物者,起始剂量为30m砂次,每日2次。结果:对中度癌症疼痛者有效率(CR PR)为89.5环(17/19),重度疼痛者为95.2%(5 9/62).总有效率为93.8%。副作用为恶心、呕吐、嗜睡、头昏、便秘等。示美施康定对晚期瘤症疼痛患者止痛治疗疗效明显,服用方便、安全、无成瘾性及呼吸抑制现象。表2参5(粱一伍) 20012,16维寿宁胶班配合化疗治疗中晚期恶性肿抽的临洋研究/尹祥敏…//山东…     

规范化三阶梯止痛疗法治疗晚期肝癌患者疼痛的临床观察

目的探讨规范化三阶梯止痛疗法治疗肝癌晚期患者疼痛的临床效果。方法将90例患者随机分为试验组与对照组,每组45例,试验组准确依照规范化三阶梯止痛原则(口服给药、按时给药、按疼痛评分给药)进行止痛;对照组按传统的三阶梯疗法进行止痛治疗。结果试验组患者通过采用规范化三阶梯止痛疗法治疗后,显效25例(55.57%),有效12例(26.67%),无效8例(17.78%),总有效率达82.23%;对照组患者通过止痛后,显效7例(15.56%),有效21例(46.67%),无效17例(37.78%),总有效率达62.23%。试验组总效率明显高于对照组(P<0.05)。结论三阶梯止痛疗法治疗晚期肝癌患者疼痛,安全可靠,给药方便。加强临床规范性,提高患者的依从性,可增强止痛效果,减轻晚期肝癌患者的痛苦,提高生存质量。     

内镜超声引导下腹腔神经丛阻滞术对初诊为晚期胰腺癌患者的止痛作用

目的 回顾分析内镜超声引导下腹腔神经丛阻滞术（EUS—CPN）对初诊为晚期胰腺癌的止痛效果。方法对8例初诊为胰腺癌患者应用EUS—CPN,在腹腔干发出处上方临近的组织内用一针法无水乙醇注射或植入125I放射线粒子。于术前、术后1周、1月时VAS法作疼痛评分,评分减少I〉3和〈3分别定义为疼痛缓解和无缓解。记录并发症。结果8例患者均经EU下穿刺活检确诊为晚期胰腺癌。7例接受一针法无水乙醇注射,1例在腹腔干旁和胰腺肿瘤内分别植入2粒和18粒放射线粒子。术前疼痛评分中有6例为重度疼痛,2例为中度疼痛;术后I周评估,6例（75％）疼痛明显缓解;1月后评价,7例（875％）患者轻度疼痛,仅1例患者为中度疼痛。患者术前VAS疼痛评分为8．0±1．51,术后1周VAS疼痛评分为5．1±1．64,与术前相比差异显著（P〈0．01）,术后1个为2．9—1．13,与术前相比差异非常显著（P〈0．01）。结论EUS-CPN对初诊为晚期胰腺癌的患者有较好的止痛作用。     

红外线偏振光治疗仪治疗老年慢性腰腿痛的疗效观察

目的观察BPM-Ⅲ-1型红外线偏振光治疗仪治疗社区常见的老年慢性腰腿痛患者的疗效。方法 96例患者均是社区内居民,随机分为治疗组和对照组,各48例,治疗组根据其诊断不同选择不同照射部位、功率、时间和模式,10次为1个疗程,1～2个疗程后观察疗效。结果两组分别在治疗前和治疗后1、3、7、14d判定患者VAS改善情况。治疗组显效32例,有效13例,无效3例,总有效率达93.7%。而对照组显效10例,有效8例,无效30例,总有效率37.5%。治疗组疗效明显优于对照组。结论红外线偏振光治疗仪具有明显的消炎、镇痛作用,可用于多种疼痛的治疗。     

健康宣教及心理疏导在老年女性压力性尿失禁患者生物反馈治疗中的应用

目的探讨健康宣教及心理疏导在老年女性压力性尿失禁(SUI)患者生物反馈治疗中的作用。方法应用UROSTYM PRO180生物反馈盆底治疗仪对45例SUI患者进行治疗,治疗前宣教疾病相关知识及治疗的重要性,治疗中陪伴指导,治疗后随访及饮食指导。结果 45例患者中,轻度SUI患者平均接受治疗8.2次,平均显效时间为第6.8次,中度SUI患者平均接受治疗11.6次,平均显效时间为第9.1次。轻度SUI患者经治疗后,22例(75.9%)治愈,6例(20.7%)症状改善,1例无效(3.4%),轻度SUI患者治疗总体有效率为96.6%。中度SUI患者经治疗后,10例(62.5%)治愈,4例(25.0%)症状改善,2例无效(12.5%),中度SUI患者治疗总体有效率为87.5%。结论老年SUI患者在生物反馈治疗中施以适当的健康宣教及心理疏导,有利于提高患者对疾病的重视、缓解精神压力、提高治疗效果。     

芬太尼透皮贴剂治疗肺癌癌痛疗效分析

目的：探讨芬太尼透皮贴剂在中重度肺癌癌痛治疗中的应用特点。方法：69例中重度肺癌癌痛患随机分成芬太尼透皮贴剂组和口服硫酸吗啡控释片组，评价其疗效和副反应。结果：芬太尼组36例中，未缓解3例，轻度缓解6例，部分缓解10例，明显缓解12例，完全缓解5例。口服硫酸吗啡按释片组分别为3例，5例，11例，10例及4例，两组相似。但是口服硫酸吗啡控释片组的消化道副反应明显。结论：对于慢性中重度肺癌癌痛患，芬太尼透皮贴剂是一种方便有效的镇痛药。     

胰腺癌疼痛的发病率及其临床特征

目的 探讨胰腺癌疼痛的发病率及其临床特征.方法 回顾性分析广州医学院附属广州市第一人民医院和中山大学附属第二医院1999年至2007年收治的415例胰腺癌病例资料,探讨癌痛发生率、临床特征及其与肿瘤部位、临床分期的关系.结果 胰腺癌疼痛发生率为65.1%(270/415),60.5%(251/415)的患者以疼痛为首发症状,Ⅰ级疼痛占42.2%(114/270),Ⅱ级疼痛44.1%(119/270),Ⅲ级疼痛13.7%(37/270).以上腹部疼痛多见,多表现为持续性或阵发性隐痛、胀痛.胰体尾癌患者的疼痛发生率为80.7%,全胰癌患者为71.4%,胰头癌患者为58.2%,胰体尾癌与胰头癌患者的疼痛发生率相差显著(P＜0.05));Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期胰腺癌患者的疼痛发生率分别为28.6%、58.1%、66.2%和78.6%,相差非常显著(P＜0.01);中、重度疼痛在Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者中所占比例分别为18.8%、44.4%、53.1%和68.2%,相差也非常显著(P＜0.01).结论 进展期胰腺癌的癌痛非常常见,发生率及严重程度随肿瘤进展而加重.     

Pain and primary lung cancer in the elderly

The study of pain in elderly patients with a primary lung cancer (PLC) deserves special attention particularly because this symptom is frequently associated with the condition and influences the management and prognosis. To study the characteristics of pain due to PLC in the elderly, we prospectively evaluated pain in all patients aged over 65 years admitted for PLC. Thirty-nine elderly patients were enrolled in 15 months (62% of all PLC). The average age was 72 years. The cancer was advanced NSCLC in most cases. Pain was present in 74.3%. It was significantly less common among those over 75 years (50% versus 85.1%; P<0.05). The pain, mild in most cases, worsened during follow-up in 55.5%. The last mean visual analogue scale score was significantly lower than the first (1.3 versus 3.6; P=0.001). The pain treatment required was based on level I in 20.6%, level II in 48.2% and level III in 31% of cases. Pain management in the elderly should be early, adequate and continued in order to preserve to a maximum the quality of life of these patients with PLC.     

老年晚期恶性肿瘤患者疼痛特征分析

目的分组了解中青年和老年晚期恶性肿瘤患者疼痛的特点,分析老年肿瘤疼痛患者疼痛评分与疼痛部位、性质及所致影响问的相关性。方法共收集127例晚期恶性肿瘤伴疼痛的患者,对其进行全面疼痛评估,分为中青年组和老年组进行比较,并对老年组资料进行相关性分析。结果患者最高疼痛评分96．8％属中重度疼痛,平均疼痛评分88．2％属轻度疼痛,疼痛部位以腹、腰、背、肩颈为主,性质通常为间歇痛、钝痛、刺痛、胀痛等。疼痛对睡眠、食欲、活动能力、情绪及人际关系均造成不良影响,中青年组和老年组比较差异无统计学意义。老年组中,平均疼痛评分与转移部位数、疼痛部位数、背部疼痛、臀髋部疼痛、酸痛、胀痛及焦虑之间呈正相关,与缓解因素之不触碰呈负相关。最高疼痛评分与疼痛部位数、胸痛、绞痛、加重因素之触碰、入睡困难及抑郁呈正相关,与无明确加重因素呈负相关。结论晚期恶性肿瘤合并疼痛者中重度疼痛发生率高,全面地评估、控制及治疗疼痛是提高晚期肿瘤疼痛患者,尤其是老年患者生活质量的关键措施。     

Quantification of aortic regurgitation using continuous and pulsed wave Doppler echocardiography

In a prospective blind study, continuous and pulsed wave Doppler echocardiography were used to predict the severity of angiographically assessed aortic regurgitation in 36 patients. High quality continuous wave spectral recordings of the regurgitant jet were obtained in 32 patients but four patients with mild aortic regurgitation had dropout of high velocity signals precluding accurate assessment. The deceleration slope of the peak to end-diastolic velocity measured by continuous wave Doppler, and pulsed wave Doppler mapping of the regurgitant jet in the left ventricle were compared with angiographic severity. The deceleration slope was significantly steeper in patients with severe rather than mild or moderate aortic regurgitation (3.65 +/- 1.04 vs. 1.89 +/- 0.42 vs. 1.52 +/- 0.59 m sec-2). A decay slope of greater than 3 m sec-2 was observed only in patients with 3+ or 4+ aortic regurgitation and a decay slope less than 1.2 m sec-2 was seen only in mild 1+ aortic regurgitation but there was considerable overlap between groups, making it difficult in individual cases to assess severity on the basis of the continuous wave deceleration slope. The pulsed wave Doppler technique was more time consuming, added little to the continuous wave Doppler assessment and underestimated severe regurgitation in almost 50% of cases. Hence, there are significant problems using either Doppler technique in quantitatively assessing aortic regurgitation.     

Epidemiology,features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey

We report on epidemiology, features, outcome, and domiciliary management of pain in patients with advanced hematological malignancies followed by an experienced hospital-based home care (HC) team. Out of 469 patients, 244 (52%) experienced a total of 284 pain syndromes. Pain intensity was rated from mild to moderate in 31% and from moderate to severe in 69% of them. The diagnosed pain mechanisms were deep somatic in 56%, superficial somatic in 15%, visceral 14%, mixed 8%, and neuropathic in 7% of pain syndromes, respectively. Incident pain was observed in 38% of all pain syndromes. In every diagnostic group, deep somatic pain was prevalent. Moreover, 85% of visceral pain syndromes were observed in patients affected by non-Hodgkin’s lymphoma (NHL). In addition, out of 284 pain syndromes, 150 (51%) were caused by bone involvement. The most frequent recognized pain provocative mechanisms were bone marrow expansions, osteolysis, lymph node enlargement, and mucositis. In our experience, an approach based on the association of causal therapies and analgesics allows optimal control of most pain syndromes. Therefore, pain is a major problem in patients affected by advanced hematological malignancies, and its management can be effective and feasible when carried out by a skilled HC team.     

The relationship between care dependency and pain in nursing home residents

ContextPain is a common health problem experienced by up to 57 % of nursing home residents which has many negative side effects, including a reduced quality of life. Several studies have been carried out on the prevalence of pain and pain management. However, these study findings remain controversial.ObjectivesTherefore, the aim of this study was to compare care dependent and care independent nursing home residents with regard to their (1) pain prevalence and levels and (2) their pain management.MethodsThis cross-sectional study is conducted annually in Austrian nursing homes. We measured pain prevalence and levels by asking questions about the pain experienced and pain level measured in the seven days prior to the interview, as well as the pain experienced at the time of this interview.ResultsThe study sample comprised 81.1 % of the 1528 residents of Austrian nursing homes. Overall, pain prevalence was higher in care dependent residents than in care independent residents. Care dependent residents experienced more often mild/moderate pain than care independent residents. Both, prevalence and levels of pain were not statistically significant different between the levels of care dependency. Care dependent residents who suffered from pain received a statistically significantly higher number of non-pharmacological interventions as compared to care independent residents who suffered from pain.ConclusionsWe identified a higher prevalence of pain among care dependent residents. Furthermore, the found differences in pain relief seem to be correlated with different degrees of care dependency, an aspect that requires further investigation.     

芬太尼透皮贴剂与口服控释吗啡治疗癌痛的自身对照研究

对35例需强阿片类药镇痛的晚期癌患者进行芬太尼贴剂的口服控释吗啡的自身对照治疗,以比较两药控制癌痛的疗效及安全性。结果发现,两药治疗癌痛的总体缓解率、副反应谱及发生率相近,但芬太尼贴剂控制癌痛的完全缓解率略高于口服控释吗啡（P＜0．05）,便秘的发生率略低（P＜0．05）。认为芬太尼透皮贴剂作为WHO第三阶梯镇痛药具有与口服吗啡相近的疗效和安全性,尤其适用于不能口服镇痛药的癌痛患者。     

The quality of pain management in pancreatic cancer: A prospective multi-center study

Background/objectivesPancreatic ductal adenocarcinoma (PDAC) is frequently associated with severe pain. Given the almost inevitably fatal nature of the disease, pain control is crucial. However, data on quality of pain management in PDAC is scarce.MethodsThis is a multi-center, prospective study to evaluate the quality of pain management in PDAC. Insufficient pain treatment (undertreatment) was prevalent if there was an incongruence between the patients level of pain and the potency of analgesic drug therapy. Determinants of pain and undertreatment were identified using multivariable logistic regression.Results139 patients with histologically confirmed PDAC were analyzed. The prevalence of pain was 63%, with approximately one third of the patients grading their pain as moderate to severe. Palliative stage (OR: 3.37, 95%CI: 1.23–9.21, p = 0.018) and localization of the primary tumor in the body or tail (OR: 2.57, 95%CI: 1.05–6.31, p = 0.039) were independent determinants of pain. Of those reporting pain, 60% were undertreated and in 89% pain interfered with activities and emotions. Age ≥ 70 years (OR: 3.20, 95%CI: 1.09–9.41, p = 0.035) was an independent predictor of undertreatment. Patients with longer-known PDAC ( ≥ 30 days) showed improved pain management compared to new cases (OR: 0.19, 95%CI: 0.05–0.81, p = 0.025). Treatment by gastroenterologists (OR: 0.22, 95%CI: 0.05–0.89, p = 0.034) was associated with less undertreatment.ConclusionsThe results show a high proportion of PDAC patients with pain, pain interference and undertreatment, whose characteristics could help to identify patients at risk in the future. Several changes in the management of cancer-related pain are necessary to overcome barriers to optimal treatment.