作者：王清睿，梁璇，张长春

单位：江汉大学附属医院 肿瘤科，湖北 武汉 430015

Authors: Wang Qingrui，Liang Xuan，Zhang Changchun

Unit: Department of Oncology, Affiliated Hospital of Jianghan University, Wuhan 430016, Hubei, China

摘要：

目的 观察热疗联合阿片类药物治疗消化系统中重度癌性疼痛（简称癌痛）患者的临床效果。方法 选择江汉大学附属医院肿瘤科2017年1月至2020年1月门诊或住院治疗的74例消化系统中重度癌痛患者根据镇痛方案不同分为两组，对照组（n=37）仅采用强阿片类药物治疗癌痛，观察组（n=37）在对照组镇痛治疗基础上加用腹腔内生场热疗，两组疗程均为30 d。采用数字分级法（NRS）评估两组患者治疗前后平均疼痛评分、暴发痛评分、24 h暴发痛次数，采用酶联免疫检测方法 检测两组患者治疗前后血清β-内啡肽（β-EP）和P物质（SP）表达水平；比较两组患者治疗期间盐酸羟考酮缓释片每日用药量及不良反应发生率；采用简明疼痛评估量表（BPI）评估两组患者治疗前后生活质量。结果 两组患者治疗后平均疼痛评分、暴发痛评分、24 h暴发痛次数较治疗前均明显降低（P<0.05），且观察组治疗后降低幅度较对照组治疗后显著（P<0.05）；两组患者治疗后血清β-EP表达水平较治疗前显著升高（P<0.05），而血清SP表达水平较治疗前显著降低（P<0.05），且观察组治疗后升高和降低幅度较对照组治疗后显著（P<0.05）；观察组患者盐酸羟考酮缓释片每日用药量显著少于对照组（P<0.05），且恶心呕吐、便秘、排尿困难及肝功能损害等不良反应发生率显著低于对照组（P<0.05）；两组患者治疗后BPI评分较治疗前均显著降低（P<0.05），且观察组治疗后降低幅度较对照组治疗后显著（P<0.05）。结论 热疗联合阿片类药物可有效提高消化系统中重度癌痛患者镇痛效果，减少阿片类药物治疗剂量和不良反应，改善生活质量。

关键词：热疗；阿片类药物；消化系统；癌痛

Abstract：

Objective To observe the clinical effect of hyperthermia combined with opioids in treat[1]ment of patients with moderate to severe cancer pain in digestive system. Method The 74 patients with severe cancer pain in the digestive system who were selected for outpatient or inpatient treatment from January 2017 to January 2020 in the Department of Oncology of Jianghan University Affiliated Hospital were divided into two groups according to different analgesia schemes. The control group （n= 37 cases ） was only applied strong opioids to treat cancer pain, while the observation group （n=37 cases） was used intra-abdom[1]inal hyperthermia besides the analgesia treatment. The course of treatment was 30 days in both groups. The average pain scores, burst pain scores, and 24-hour burst pain times of the two groups were evaluated by numerical rating scale （NRS） before and after the treatment. Enzyme-linked immunoassay was used to detect the expression of serum β-endorphin （β-EP） and substance P （SP） before and after treatment. The daily dosage of Oxycodone Hydrochloride Prolonged-release Tablets and the incidence of adverse reactions were compared during the treatment of two groups; Brief pain inventory （BPI） was used to assess the quality of life of the two groups before and after treatment. Result After treatment, the average pain score, burst pain score, and 24-hour burst pain times of the two groups were significantly lower than those before treatment （P<0.05）, and the reduction in observation group after treatment was more significant than that in control group （P<0.05）; the serum β-EP expression level of the two groups after treatment was significantly higher than that before treatment （P<0.05）, while the serum SP expression level was significantly lower than that before treatment（P<0.05）, and the range of increase and decrease in observation group after treatment was more obvious than that after treatment in control group （P<0.05 ）; the daily dosage of Oxycodone Hydrochloride Prolonged[1]release Tablets in observation group was significantly less than that in control group （P<0.05）, and the incidence of adverse reactions such as nausea and vomiting, constipation, dysuria, and liver damage were significantly lower than those in control group （P<0.05）; the quality of life scores for the two groups after treatment were significantly lower than those before treatment （P <0.05）, and the reduction in observation group after treatment was more significant than that after treatment in control group （P<0.05）. Conclusion Hyperthermia combined with opioids can effectively improve the analgesic effect of patients with moderate to severe cancer pain in digestive system, reduce the dose and adverse reactions of opioids, and improve the quality of life.

Key Words: Hyperthermia；Opioids；Digestive system；Cancer pain