不同阿片类镇痛药联合放射治疗骨转移癌痛的疗效观察

目的 观察不同阿片类镇痛药联合局部放射治疗骨转移癌痛的镇痛效果及生活质量的变化.方法 晚期肿瘤骨转移癌痛患者60例,随机分为局部放射治疗加口服氨酚羟考酮组（RO组,n=30）和局部放射治疗加口服美菲康组（RM组,n=30）.两组患者骨转移疼痛部位以大分割放射治疗,分割剂量DT 3 Gy/次,1次/d,5次/周,总剂量：脊椎部位DT 30 Gy/10次,非脊椎部位DT 39～45 Gy/13～15次.同时不同分组给予相应的口服药物,于治疗结束后2周、8周时评定镇痛效果及生活质量变化.结果 治疗结束后2周时镇痛总有效率分别为RO组90.o%（27/30例）,RM组86.7%（26/30例）,治疗结束后8周时镇痛总有效率分别为RO组96.7%（29/30例）,RM组93.3%（28/30例）,两组镇痛效果无统计学差异（P〉0.05）,两组患者生活质量明显提高（P〈0.05）.结论 放射治疗辅助El服氨酚羟考酮或美菲康均是有效、简便、易行的治疗晚期肿瘤骨转移癌痛的方法,同时可提高患者的生活质量.

Efficacy of different opioid analgesics combined with radiation therapy on the patients with bone metas-tasis callcer pain

Objective To observe the analgesic effect of different opioid analgesics in combination with local radiation therapy on the treatment of metastatic bone cancer pain and quality of life. Methods Sixty patients with advanced tumors of bone metastasis with cancer pain were randomly divided into local radiotherapy combined with oxycodone acetaminophen （group RO, n： 30） or morphine hydrochloride （group RM, n= 30）. All patients in the two groups were treated by hypofractionated radiotherapy with 3 Gy each time and once a day, five times a week. The total dosage was 30 Gy at spine vertebral bone and 39-45 Gy at nonspine vertebral bone. At the same time, oxycodone acetaminophen and morphine hydrochloride were respectively given to the patients in group RO and group RM. The analgesic effect and quality of life were measured at 2 and 8 weeks after the treatment. Results The total efficacy rate was 90.0% （27/30 cases） in group RO and 86.7% （26/30 cases） in group RM at 2 weeks after the treatment and that was 96.7% （29/30 cases） in group RO and 93.3%（28/30 cases） in group RM at 8 weeks after the treatment with no significant difference between the two groups. The quality of life in all patients was improved significantly in the two groups after the treatment. Conclusion Oral oxycodone acetaminophen or morphine hydrochloride combined with radiotherapy is all an effective, simple and easy operated method to treat the patients with bone metastasis pain, and improve the quality of life.