氢溴酸高乌甲素联合阿片类药治疗中重度神经病理性癌痛疗效观察

目的探讨氢溴酸高乌甲素联合阿片类药与单独应用阿片药治疗中重度神经病理性癌痛的疗效差别。方法2003年1月至2007年12月间我院肿瘤科收治了63例神经病理性癌疼痛患者,Karnofsky评分50～80分,随机分为两组,其中A组采用氢溴酸高乌甲素联合阿片类镇痛药（32例）;B组单用阿片类镇痛药（31例）;疼痛评估采用视觉模拟评分法（visual analogue scale,VAS）,分析第0、3、10天的变化;评价两组阿片药品的消耗量以及不良反应的发生率。结果A、B组的VAS评分基线值差异无显著性（P=0.452）。从疼痛的缓解程度来看,VAS评分下降程度A组要好于B组,差异有显著性（P〈0.05）;从阿片类药物的消耗来看,B组明显要多于A组;阿片不良反应B组多于A组（P=0.015）。结论氢溴酸高乌甲素联合阿片类药可以更好地治疗患者神经病理性癌痛,减少了阿片药品的用量,降低了因为阿片药带来的不良反应,是治疗中重度神经病理性癌痛安全有效的办法。

Lappaconite hydrobromide combined with an opioid for the management of neuropathic cancer pain

Objective To compare the effectiveness and safety of lappaconite hydrobromide combined with an opioid versus opioid monotherapy for the management of neuropathic cancer pain. Methods Sixty-three patients with neuropathic cancer pain and Karnofsky score from 50 to 80 were investigated retrospectively. The patients were divided randomly into 2 groups： in group A, 32 patients received lappaconite hydrobromide combined with an opioid, and in group B,31 patients received opioid monotherapy for the management of neuropathic cancer pain according to the World Health Organization treatment ladder approach. Visual analogue scale （VAS）was applied for pain evaluation. Changes in pain intensity and analgesic drug consumption were evaluated on day 0, day 3 and day 10. Side effects were also recorded. Results No significant statistical difference in the baseline VAS values was found between the two groups. For the relief of pain, significant decrease in pain intensity（ P 〈 0. 05 ） was observed in the group A compared with the group B. Opioid consumption was higher in group B than in group A. The rate of side effects in group A was significantly lower than that in group B （P = 0. 015 ）. Conclusion These data suggested that lappaconite hydro- bromide added to an opioid provided better relief of neuropathic pain in cancer patients than opioid monotherapy. Combination of lappaconite hydrobromide with an opioid may represent a more safe and effective regimen than opioid monotherapy for the management of neuropathic cancer pain.