耳穴压贴法联合三阶梯止痛法治疗中重度癌痛的疗效分析研究

背景　大量中重度癌痛患者在西药的镇痛药物治疗过程中常出现难以耐受的不良反应，中医耳穴压贴法的联合治疗效果值得探究。目的　观察耳穴压贴法联合三阶梯止痛法治疗中重度癌痛的临床疗效。方法　选择2017—2018年上海市浦东新区迎博社区卫生服务中心舒缓疗护病房收治的癌症晚期并伴有中重度癌痛患者60例，采用随机数字表法将其分为对照组和治疗组，各30例。对照组采用三阶梯止痛法，治疗组采用三阶梯止痛法联合耳穴压贴法治疗。1周后观察两组疼痛程度、镇痛药物〔盐酸羟考酮控释片（奥施康定）〕使用剂量和恶心呕吐、便秘的发生情况及抑郁状态。采用数字评分法（NRS）评估疼痛程度，采用汉密尔顿抑郁量表（HAMD）评估抑郁状态。结果　两组NRS疼痛评分减轻程度比较，差异无统计学意义（Z=0.106，P=0.916）。滴定1周后，治疗组使用的奥施康定药物剂量为40（20，60）mg/24 h，低于对照组的40（40，60）mg/24 h（Z=2.067，P=0.039）。治疗组恶心、呕吐严重程度轻于对照组（Z=2.395，P=0.017）。治疗组便秘发生率为16.7%（5/30），低于对照组的43.3%（13/30）（χ2=5.079，P=0.024）。治疗1周后，治疗组HAMD评分低于对照组（P<0.05）。结论　耳穴压贴法联合三阶梯止痛法治疗中重度癌痛可以有效减少镇痛药物使用剂量，缓解消化系统不良反应，并改善患者抑郁状态，具有一定的临床推广应用价值。

Clinical Observation on Auricular Acupressure Therapy Combined with Three-step Analgesic Ladder Therapy for Moderate to Severe Cancer Pain

Background　A large number of patients with moderate to severe cancer pain have intolerable adverse reactions during the analgesic treatment with commonly used western medicine.The therapeutic effect of auricular acupressure therapy combined with traditional Chinese medicine is worth exploring.Objective　To explore the clinical effects of auricular acupressure therapy combined with three-step analgesic ladder therapy for moderate to severe cancer pain.Methods　A total of 60 advanced cancer patients with moderate to severe cancer pain were selected from the Hospice Care Ward of Yingbo Community Health Service Center in Pudong New Area in Shanghai from 2017 to 2018.They were divided into the control group and the treatment group by random number table method by 30 in each.The patients in control group were given the three-step analgesic ladder therapy，while the patients in treatment group were given auricular acupressure therapy on the basis of the control group.The analgesic effect，medication（Oxycontin） dosage，the incidence of nausea，vomiting and constipation along with the improvement of depression were observed after one-week treatment.Numerical Rating Scale（NRS） was used to assess the degree of pain，and Hamilton Depression Scale（HAMD） was used to assess the state of depression.Results　There was no significant difference in NRS pain scores between the two groups（Z=0.106，P=0.916）.The dosage of Oxycontin used in the treatment group was 40（20，60）mg/24 h，which was lower than that in the control group〔40（40，60）mg/24 h〕（Z=2.067，P=0.039） after one-week titration.The severity of nausea and vomiting in the treatment group was lighter than that in the control group（Z=2.395，P=0.017）.The incidence of constipation in the treatment group was 16.7%（5/30），which was lower than 43.3%（13/30） in the control group（χ2=5.079，P=0.024）.The HAMD score of the treatment group was lower than that of the control group after one-week treatment（P<0.05）.Conclusion　Auricular acupressure therapy combined with three-step analgesic ladder therapy can effectively reduce the dosage of analgesics，alleviate adverse reactions of the digestive system，and improve the depression of patients with moderate to severe cancer pain，which has the certain clinical application value and thus deserving popularization.