普瑞巴林联合阿片类药物治疗癌性神经病理性疼痛的临床研究

目的 观察普瑞巴林联合阿片类药物治疗癌性神经病理性疼痛（MNP）的疗效。方法 2011年8月至2014年1月间52例中度以上MNP患者采用简单随机抽样法分为：A组（17例），仅接受吗啡；B组（18例），接受吗啡加75mg普瑞巴林（每日2次）；C组（17例），接受吗啡加150mg普瑞巴林（每日2次）。患者采用静脉自控镇痛（PCIA）方式给予吗啡注射72h，滴定其所需剂量。72h后将吗啡换成口服羟考酮控释片，继续治疗4周。分析A、B、C 3组每24h吗啡用量，PCIA期间及口服羟考酮控释片后的疼痛情况（爆发痛次数、静息以及活动VAS评分）并记录不良反应。结果 与A组比较，B组72h内、C组48h内及72h内的每24h吗啡用量较低，差异均有统计学意义（P＜0.05）；C组72h内爆发痛次数及活动VAS评分均低于A组，差异有统计学意义（P＜0.05）；吗啡PCIA滴定期间，3组均未出现严重不良反应，常见不良反应为恶心、呕吐、头晕、嗜睡及便秘，组间差异均无统计学意义（P＞0.05）；A组第28天羟考酮缓释片用量（mg）为117.67±36.39，而B、C组分别为94.06±25.38和88.21±24.46，均低于A组，差异有统计学意义（P＜0.05）；B、C组第7、14、28天爆发痛次数均低于A组，差异有统计学意义（P＜0.05）；B组第14天活动VAS评分低于A组，C组第7、14天活动VAS评分均低于A组，以上差异均有统计学意义（P＜0.05）。结论 普瑞巴林联合阿片类药物治疗MNP的效果较好，优于单用阿片类药物，且普瑞巴林可能需使用较大的剂量。

Clinical study of pregabalin combined with opioids in the treatment of malignant neuropathic pain

Objective To evaluate the analgesic efficacy of pregabalin combined with opioids in the treatment of malignant neuropathic pain （MNP）. Methods Fifty-two patients with MNP of moderate to severe pain were enrolled and initially took 72 hours morphine patient control intravenous analgesia（PCIA）， randomly assigned into 3 groups： group A （n=17）， receiving morphine PCIA； group B （n=18）， receiving morphine PCIA plus 75mg pregabalin （per 12h）； group C （n=17）， receiving morphine PCIA plus 150mg pregabalin （per 12h）. The oxycodone was calculated and substituted for morphine 72h after morphine PCIA for continuous 4 weeks. The 24h dosage of morphine was analyzed in 3 groups. The number of break-through pain， resting visual analogue scale （VAS） and VAS at activity during PCIA period and oral administration of oxycodone were recorded in 3 groups as well as the adverse reaction. Results Compared to group A， the dosage of every 24 hour morphine in 72h of group B and in 48， 72h of group C were low （P＜0.05）. The number of break-through pain and VAS at activity of group C were lower than group A （P＜0.05）. During the period of morphine PCIA， no serious adverse reaction were observed in 3 groups， and the common adverse reactions included nausea， vomiting， dizziness， drowsiness and constipation with not statistically significant difference among 3 groups （P＞0.05）. The dosages of oxycodone were （94.06±25.38）mg and （88.21±24.46）mg in group B and C， lower than （117.67±36.39）mg in group A with significant difference （P＜0.05）. The number of break through pain of group B and C at day 7， 14， 28 were lower than group A （P＜0.05）， and the VAS at activity of group B at day 14 and group C at day 7， 14 were lower than group A （P＜0.05）. Conclusion MNP may be well controlled by pregabalin plus opioid， and the dosage of pregabalin may be needed more.