芬太尼贴联合加巴喷丁治疗癌性神经病理性疼痛的疗效观察

  目的  探讨芬太尼贴联合加巴喷丁治疗癌性神经病理性疼痛的临床疗效。  方法  选择确诊为癌性神经病理性疼痛患者60例，随机分为单纯芬太尼贴治疗组（对照组）与芬太尼贴联合加巴喷丁组（联合组）。对照组对以前用过强阿片类药物的患者根据用药情况进行剂量转换，逐渐增量，直至疼痛缓解VAS < 3分或爆发痛 < 3次；联合组在使用芬太尼贴的基础上加用加巴喷丁，初始剂量为100 mg 3次/日，逐渐增加剂量，直至疼痛缓解，但总用量≤2 400 mg/日。观察治疗前、治疗后1、2、3和4W的VAS评分、生活质量评分（QOL）、疼痛缓解程度、阿片类药物的使用量及不良反应。  结果  治疗后对照组与联合组VAS评分均有下降（P < 0.05），联合组更明显（P < 0.05）；QOL两组较治疗前均有改善（P < 0.05），联合组改善显著（P < 0.05）；对照组总有效率为83.3%，联合组为96.7%；联合组阿片类药物使用量较对照组明显减少，药物的不良反应明显降低P < 0.05）。  结论  芬太尼贴联合加巴喷丁治疗癌性神经病理性疼痛疗效显著，安全性高，不良反应低，值得临床推广。 

Assessment of transdermal fentanyl combined with gabapentin for malignant neuropathic pain treatment

  Objective  To observe the effect of transdermal fentanyl combined with gabapentin for the treatment of malignant neuropathic pain (MNP).  Methods  A total of 60 patients with MNP were randomly divided into two groups. A total of 30 cases in the control group received transdermal fentanyl according to the dosages of opioid medicine that patients used. Such dosages were gradually increased until the pain relief visual analogue scale (VAS) fell below 3 or until the times of breakthrough pain became less than 3. For the combined group, gabapentin was co-administered with transdermal fentanyl, similar to the control group. Initially, 100 mg of gabapentin was administered thrice a day. This dosage was gradually increased until pain relief. However, gabapentin dosages were kept below 2, 400 mg a day. VAS, quality of life (QOL), degree of pain relief, dosages of fentanyl and morphine, and side effects were evaluated before treatment and at one, two, three, and four weeks after the treatment.  Results  Both groups exhibited lower VAS after treatment (P < 0.05), but the difference was observed to be more significant in the combined group than that in the control group (P < 0.05). Both groups exhibited improved QOL (P < 0.05), which was observed to be more significant in the combined group than in the control group (P < 0.05). The effective rate was 96.7% in the combined group and 83.3% in the control group. The dosage of opioid medicine and the side effects in the combined group were less than those in the control group.  Conclusion  Transdermal fentanyl combined with gabapentin is effective for the treatment of malignant neuropathic pain.