奥施康定联合氯诺昔康治疗骨转移癌疼痛的临床观察

目的 探讨奥施康定联合氯诺昔康治疗骨转移癌患者中重度疼痛的疗效及安全性.方法 将283例患者随机分为两组,实验组（145例）接受奥施康定＋氯诺昔康治疗,对照组（138例）接受奥施康定治疗.实验组中氯诺昔康片的用法为8 mg bid,与奥施康定同日开始服用.实验组及对照组中所有患者均使用奥施康定滴定,由10 mg q12h开始使用,根据疼痛缓解程度进行剂量调整,达到疼痛缓解时（疼痛NRS评分≤3分）,维持治疗直到观察终点,观察用药10d后两组的镇痛疗效及不良反应.结果 实验组与对照组在用药10d内所有患者疼痛明显缓解.实验组使用高剂量奥施康定人数比例为20％,而对照组为31.2％,实验组高剂量人群比例低于对照组,差异有统计学意义（P＜0.05）.实验组与对照组便秘发生率分别为14.5％和25.4％,实验组便秘发生率低于对照组,差异有统计学意义（P＜0.05）.但实验组与对照组在头昏、呕吐、呼吸困难、排尿困难、转氨酶增高等不良反应方面差异均无统计学意义（P＞0.05）.结论 氯诺昔康联合奥施康定可以控制骨转移癌的疼痛;联合用药显著减少了高剂量奥施康定使用的人数,氯诺昔康增加了其止痛效果,且减少了便秘的发生;奥施康定联合氯诺昔康治疗可作为临床治疗骨转移癌疼痛的一种较理想的治疗选择.

Clinical observation of OxyContin combined with Lornoxicam for pain in patients with bone metastases

Objective To investigate the efficacy and safety of OxyContin combined with lomoxicam in the treatment of the moderate to severe pain in patients who suffered from bone metastases. Methods A total of 283 pa- tients were randomly divided into two groups. The experiment group （n=145） received OxyContin combined with Lor- noxicam, and the control group （n=138） received only OxyContin. Lomoxicam was given 8 mg bid in experiment group at the same time as OxyContin was used. Initial dosage of OxyContin was 10 mg ql2h for both groups. Dosage was adjusted according to the degree of pain relief （NRS score ≤3）. The efficacy and adverse reactions were observed 10 days after treatment. Results Patients in both groups got pain released within 10 days. The experiment group （20%） had a lower proportion who need high dosage of OxyContin, compared with the control group （31.2%）, with statistically significant difference between the two groups （P〈O.05）. The occurrence of constipation was also lower in experiment group （14.5%） than the control group （25.4%）, with statistically significant difference （P〈0.05）. The two groups showed no statistically significant difference in the incidence of adverse effects including faint, vomiting, dys- pnea, dysuresia, and increased transaminase. Conclusion Combination of OxyContin and Lornoxicam has a signifi- cant reduction in proportion of high-dose populations, which enhances the analgesic effect and reduces the incidence of constipation, and serves as a better therapeutic choice for the pain in patients with bone metastase in clinic.