鳖甲煎丸联合足三里穴位注射治疗原发性肝癌轻中度癌痛临床疗效
|
摘要
目的:观察鳖甲煎丸联合穴位注射治疗原发性肝癌轻中度癌痛的临床疗效。方法:将80例经确诊为原发性肝癌患者随机分为对照组和治疗组。对照组轻度癌痛患者给予吲哚美辛肠溶片口服,25 mg/次,3次/d。中度癌痛患者给予盐酸曲马多缓释片口服,100 mg/次,2次/d。治疗组轻度、中度癌痛患者均给予鳖甲煎丸口服,3 g/次,每日3次。双侧足三里穴位注射复方苦参注射液各2 ml,隔日1次。4周为一个疗程。一个疗程后,观察两组患者治疗前后疼痛评分变化,疼痛缓解率比较,治疗前后生存质量评价,治疗前后饮食量与体重变化,治疗前后肝功能、甲胎蛋白定量测定,以及记录不良反应发生情况。结果:治疗后,两组患者的疼痛评分均降低,治疗组患者的疼痛评分显著低于对照组,差异有统计学意义(P <0.05);治疗组疼痛缓解率为85%,对照组疼痛缓解率为72.5%,差异有统计学意义(P <0.05);治疗组在日常生活、情绪、行走能力、日常工作、与他人关系、睡眠、生活兴趣方面,因疼痛导致的影响均小于对照组,差异均有统计学意义(P <0.05);治疗组食量增加高于对照组,差异有统计学意义(P <0.05);治疗后两组患者体重变化治疗组小于对照组,比较差异有统计学意义(P <0.05);治疗组患者肝功能、甲胎蛋白改善均优于对照组,且差异均有统计学意义(P <0.05);治疗组不良反应发生率为30%,对照组不良反应发生率为65%,差异有统计学意义(P <0.05)。结论:鳖甲煎丸联合针刺与穴位注射治疗原发性肝癌轻中度癌痛的疗效确切,能明显改善化疗后患者的生存质量,减少不良反应发生,值得在临床上推广应用。
Objective: To observe the clinical efficacy of Biejiajian Pills and acupoint injection in treating mild-moderate cancer pain of primary liver cancer. Methods: 80 patients with primary liver cancer were randomly and equally allocated into treatment group or control group. The patients of mild cancer pain in the control group were given Indometacin Enteric-coated Tablets orally(25 mg/time, tid), and the patients of moderate cancer pain in the control group were given Tramadol Hydrochloride Sustained-release Tablets orally(100 mg/time, bid). Patients with mild and moderate cancer pain allocated into treatment group were treated by Biejiajian Pills orally(3 g/time, tid) and Compound Sophorae injection to bilateral acupoints Zusanli(ST 36)(4 ml/time, qod). After a course treatment of 4 weeks, the scores of cancer pain, effective rate of pain relief, life quality of cancer patients, nutritional status, hepatic function and alpha fetal protein test, and adverse reactions were observed and compared after the treatment cycles. Results: After the treatment, the pain scores of the patients in the two groups decreased, and the pain score of the patients in the observation group was significantly lower than that of the patients in the control group(P < 0.05). The effective rates of pain relief of the patients in the observation group and the control group were respectively 85% and 72.5%(P < 0.05). Nutritional status of the observation group was better than that of the control group, and the difference was statistically significant(P < 0.05). The improvement of hepatic function and alpha fetal protein test in the observation group was better than that of control group(P < 0.05). The incidence rates of adverse actions in the treatment group were all lower than the control group. The observation group was 30%, and the control group was 65%(P < 0.05). Conclusion: Biejiajian Pills and acupoint injection may effectively and safely relieve the level of cancer pain and improve quality of life in patients with primary liver cancer.Results of this study will provide evidence for the use of Biejiajian Pills and acupoint injection in clinical practice.
Objective: To observe the clinical efficacy of Biejiajian Pills and acupoint injection in treating mild-moderate cancer pain of primary liver cancer. Methods: 80 patients with primary liver cancer were randomly and equally allocated into treatment group or control group. The patients of mild cancer pain in the control group were given Indometacin Enteric-coated Tablets orally(25 mg/time, tid), and the patients of moderate cancer pain in the control group were given Tramadol Hydrochloride Sustained-release Tablets orally(100 mg/time, bid). Patients with mild and moderate cancer pain allocated into treatment group were treated by Biejiajian Pills orally(3 g/time, tid) and Compound Sophorae injection to bilateral acupoints Zusanli(ST 36)(4 ml/time, qod). After a course treatment of 4 weeks, the scores of cancer pain, effective rate of pain relief, life quality of cancer patients, nutritional status, hepatic function and alpha fetal protein test, and adverse reactions were observed and compared after the treatment cycles. Results: After the treatment, the pain scores of the patients in the two groups decreased, and the pain score of the patients in the observation group was significantly lower than that of the patients in the control group(P < 0.05). The effective rates of pain relief of the patients in the observation group and the control group were respectively 85% and 72.5%(P < 0.05). Nutritional status of the observation group was better than that of the control group, and the difference was statistically significant(P < 0.05). The improvement of hepatic function and alpha fetal protein test in the observation group was better than that of control group(P < 0.05). The incidence rates of adverse actions in the treatment group were all lower than the control group. The observation group was 30%, and the control group was 65%(P < 0.05). Conclusion: Biejiajian Pills and acupoint injection may effectively and safely relieve the level of cancer pain and improve quality of life in patients with primary liver cancer.Results of this study will provide evidence for the use of Biejiajian Pills and acupoint injection in clinical practice.
引文
1刘厚钰.原发性肝癌.北京:人民卫生出版社, 2005:450.
2 黄岚,丁亚香. 183例中晚期肝癌患者的疼痛原因分析及护理.现代中西医结合杂志, 2000, 9(13):7.
3 Radha Krishna LK, Poulose JV, Tan BS, etc. Opioid use amongst cancer patients at the end of life. Ann Acad Med Singapore. 2010, 39(10):790-797.
4 王丹.鳖甲煎丸化裁对肝癌22荷瘤小鼠抗肿瘤作用的实验研究.中华中医药学刊, 25(3):582-584.
5 程旸,贺松其,朱云,等.鳖甲煎丸抑制肝癌细胞增殖黏附及侵袭作用的实验研究.中国中西医结合杂志, 2013, 33(5):664-667.
6 孙阳,吴勃岩,车艳新,等.鳖甲煎丸诱导肝癌细胞凋亡及对STAT信号通路的影响.时珍国医国药, 27(4):849-851.
7 周杰,梁宜,陈勤,等.穴位注射治疗癌痛随机对照研究的Meta分析.浙江中医药大学学报, 38(7):927-932.
8 中华医学会编著临床诊疗指南.肿瘤分册.北京:人民卫生出版社,2005:11.
9 郭帅.复方苦参注射液治疗Ⅲ~Ⅳ期癌症患者癌性疼痛临床疗效.药物评价研究, 38(3):306-309.
10 孙燕,石远凯.临床肿瘤内科手册.北京:人民卫生出版社, 2012,第5版:258-260.
11 元建华,赵清梅,廖燕,等.复方苦参注射液联合硫酸吗啡缓释片治疗中重度癌痛的临床观察.中国疼痛医学杂志, 2015, 21(1):79-80.
12 周宜强.实用中医肿瘤学.北京.中医古籍出版社, 2011:582-583.
13 曹阳.鳖甲煎丸加减在原发性肝癌治疗中的应用.中国中医基础医学杂志, 2000, 6(7):30-31.
14 杨亚琴,刘永军.中医药治疗癌性疼痛的现状及展望.光明中医,2014, 29(7):1580-1581.
15 何秀兰,肖俐,刘传波,等.鳖甲煎化裁与局部微创相结合治疗原发性肝癌38例临床观察.中国中医基础医学杂志, 2013, 19(4):470-472.
16 汤新跃.经方鳖甲煎丸抑制H22肝癌细胞血管生长的实验研究.陕西中医, 2015, 36(7):929-930.
17 罗庆东,王月飞,赵红晔,等.鳖甲煎丸对肝癌荷瘤小鼠肿瘤组织生长及转移的影响.中国实验方剂学杂志, 2012, 18(14):230-232.
18 贾文燕,贺松其,文彬,等.鳖甲煎丸对肝癌细胞周期及Wnt/β-catenin信号通路中β-catenin、COX-2蛋白表达水平的影响.中华中医药杂志, 2015, 30(8):2964-2967.
19 梁繁荣.针灸学.北京:中医药出版社, 2005, 1:236.
20 卞镝,张宁苏,成泽东.穴位注射加灸对癌痛患者外周血中B-内啡肽的影响.辽宁中医杂志, 2004, 31(3):246-247.
21 海丽娜,张志伟,王金华,等.复方苦参注射液对小鼠的镇痛止血和抗应激作用.中国实验方剂学杂志, 2012, 18(2):199-201.
22 王景洁,何安兵,付美霞,等.复方苦参注射液对肝癌细胞survivin表达的影响.中国医院药学杂志, 2011, 31(21):1770-1773.
23 叶正青,梁重峰,丁海,等.复方苦参注射液对人肝癌SMMC-7721肿瘤细胞作用的实验研究.山东医药, 2009, 49(16):44-45.
2 黄岚,丁亚香. 183例中晚期肝癌患者的疼痛原因分析及护理.现代中西医结合杂志, 2000, 9(13):7.
3 Radha Krishna LK, Poulose JV, Tan BS, etc. Opioid use amongst cancer patients at the end of life. Ann Acad Med Singapore. 2010, 39(10):790-797.
4 王丹.鳖甲煎丸化裁对肝癌22荷瘤小鼠抗肿瘤作用的实验研究.中华中医药学刊, 25(3):582-584.
5 程旸,贺松其,朱云,等.鳖甲煎丸抑制肝癌细胞增殖黏附及侵袭作用的实验研究.中国中西医结合杂志, 2013, 33(5):664-667.
6 孙阳,吴勃岩,车艳新,等.鳖甲煎丸诱导肝癌细胞凋亡及对STAT信号通路的影响.时珍国医国药, 27(4):849-851.
7 周杰,梁宜,陈勤,等.穴位注射治疗癌痛随机对照研究的Meta分析.浙江中医药大学学报, 38(7):927-932.
8 中华医学会编著临床诊疗指南.肿瘤分册.北京:人民卫生出版社,2005:11.
9 郭帅.复方苦参注射液治疗Ⅲ~Ⅳ期癌症患者癌性疼痛临床疗效.药物评价研究, 38(3):306-309.
10 孙燕,石远凯.临床肿瘤内科手册.北京:人民卫生出版社, 2012,第5版:258-260.
11 元建华,赵清梅,廖燕,等.复方苦参注射液联合硫酸吗啡缓释片治疗中重度癌痛的临床观察.中国疼痛医学杂志, 2015, 21(1):79-80.
12 周宜强.实用中医肿瘤学.北京.中医古籍出版社, 2011:582-583.
13 曹阳.鳖甲煎丸加减在原发性肝癌治疗中的应用.中国中医基础医学杂志, 2000, 6(7):30-31.
14 杨亚琴,刘永军.中医药治疗癌性疼痛的现状及展望.光明中医,2014, 29(7):1580-1581.
15 何秀兰,肖俐,刘传波,等.鳖甲煎化裁与局部微创相结合治疗原发性肝癌38例临床观察.中国中医基础医学杂志, 2013, 19(4):470-472.
16 汤新跃.经方鳖甲煎丸抑制H22肝癌细胞血管生长的实验研究.陕西中医, 2015, 36(7):929-930.
17 罗庆东,王月飞,赵红晔,等.鳖甲煎丸对肝癌荷瘤小鼠肿瘤组织生长及转移的影响.中国实验方剂学杂志, 2012, 18(14):230-232.
18 贾文燕,贺松其,文彬,等.鳖甲煎丸对肝癌细胞周期及Wnt/β-catenin信号通路中β-catenin、COX-2蛋白表达水平的影响.中华中医药杂志, 2015, 30(8):2964-2967.
19 梁繁荣.针灸学.北京:中医药出版社, 2005, 1:236.
20 卞镝,张宁苏,成泽东.穴位注射加灸对癌痛患者外周血中B-内啡肽的影响.辽宁中医杂志, 2004, 31(3):246-247.
21 海丽娜,张志伟,王金华,等.复方苦参注射液对小鼠的镇痛止血和抗应激作用.中国实验方剂学杂志, 2012, 18(2):199-201.
22 王景洁,何安兵,付美霞,等.复方苦参注射液对肝癌细胞survivin表达的影响.中国医院药学杂志, 2011, 31(21):1770-1773.
23 叶正青,梁重峰,丁海,等.复方苦参注射液对人肝癌SMMC-7721肿瘤细胞作用的实验研究.山东医药, 2009, 49(16):44-45.