加巴喷丁联合吗啡应用于癌痛的临床研究

目的　观察加巴喷丁联合阿片类药物治疗癌痛的临床效果以及对患者免疫功能的影响。方法　采取随机、对照试验方法，３５例晚期恶性肿瘤伴疼痛的患者，年龄３２～６９岁，随机分为３组：吗啡组（Ｍ组）１１例，加巴喷丁组（Ｇ组）１３例，加巴喷丁＋吗啡组（ＧＭ组）１１例。达到疼痛缓解时（ＶＡＳ评分≤３分）维持给药直至观察终点，然后比较治疗前后的疼痛缓解程度、吗啡日均消耗量、生活质量和毒副反应，并检测疼痛介质（５ ＨＴ、ＮＥ）和免疫功能各指标（ＩｇＡ、ＩｇＭ、ＩｇＧ；ＣＤ４、ＣＤ８、ＮＫ细胞）的改变。结果　（１）疼痛程度的改变大小：与治疗前相比，３组均有不同程度的缓解，ＧＭ组大于Ｍ组（Ｐ＜０.０５）和Ｇ组（Ｐ＜０.０５）；（２）吗啡消耗量：ＧＭ组比Ｍ组少（Ｐ＜０.０５）；（３）疼痛介质检测值：３组在治疗后均低于治疗前（Ｐ＜０.０５）；（４）毒副反应：ＧＭ组较Ｍ组和Ｇ组轻；（５）生活质量：ＧＭ组较Ｍ组和Ｇ组明显提高；（６）免疫功能指标：３组各项免疫指标在治疗后高于治疗前（Ｐ＜０.０５）。结论　加巴喷丁联合吗啡能有效地控制癌痛，减少吗啡的用量及其副反应，并能提高患者生活质量，改善免疫功能。

The clinical therapeutic effect of gabapentin combined opioid to cancer pain

Objective To investigate the efficacy and safety of gabapentin combined opioid for cancer pain. Methods Thirty-five patiens who suffered pain of cancer disease, VAS scores ≥6, age ranged from 32 to 69, were randomized into three groups： group M, group G and group GM. We recorded the pain score by VAS, dose consumption, side effect, quality of life, detected the me- diators releated to pain, detected CD4,CD8 and NK cell by flow cytometry, and detected NE, 5-HT, IgG, IgA, IgM by ELISA. Resuits Pain relief was better in the group GM compared with the other groups （ P 〈 0. 05 ） ; the morphine consumption of group GM was less more than group M（ P 〈 0. 05 ） ,and gabapentin reduced opioid-related adverse effects; there were no statistical significance in the changes of index of immunity of all patients, and the mediators releated to pain of three groups after treatment were lower than before（ P 〈 0. 05）. Conclusion The synergistic effect of gabapentin and morphine can effectively reduce cancer pain, morphine consumption, and morphine-related adverse effects of patiens who suffer from cancer pain ; and improves immune function of patients.