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[目的]探讨对伴有抑郁情绪的癌痛患者止痛治疗的同时,运用抗抑郁药物进行辅助性干预,观察其临床效果。[方法]采用回顾性研究方法收集86例伴中重度抑郁情绪的癌痛患者,根据治疗方案分为两组,一组为文拉法辛联合阿片类药物治疗(联合用药组,41例),另一组为单纯阿片类药物治疗(对照组,45例)。两组患者均于治疗前及治疗后2周完成了抑郁自评量表(SDS)、癌症患者生活质量量表(EORTC QLQ-C30 v3.0)及疼痛缓解度(PAR)评价。[结果]联合用药组癌痛总缓解率为85.3%,对照组总缓解率为77.8%,无统计学差异(P>0.05);治疗2周后联合用药组奥施康定平均剂量(53±36.9)mg;对照组奥施康定平均剂量(70±50.4)mg,存在统计学差异;回归分析显示癌痛患者的抑郁情绪受年龄、婚姻状况、医保类型及疼痛评分的影响,两组在治疗前抑郁水平无明显差异,治疗2周后联合用药组抑郁情绪改善更为明显;癌痛患者的生活质量普遍较差,治疗2周后患者的总体生命质量、躯体功能、角色功能、情感功能、社会功能均优于治疗前,联合治疗组在情感功能和社会功能两个维度显著优于对照组。[结论]阿片类药物联合吗啡滴定可达到良好的止痛效果;伴有中重度抑郁情绪的癌痛患者,联用抗抑郁药物可明显改善患者的抑郁情绪,获得更好的止痛效果,提高患者的生活质量。
[Objective] To explore the clinical effect of anti-depressant drugs for the interventional treatment of pain-relieving patients with cancer pain. [Methods] A retrospective study was conducted to collect 86 cases of cancer pain patients with moderate and severe depression. The patients were divided into two groups according to the treatment plan. One group was venlafaxine plus opioid (combination group, 41 cases) The other group was simple opioid treatment (control group, 45 cases). Two groups of patients completed self-rating depression scale (SDS), quality of life questionnaire for cancer patients (EORTC QLQ-C30 v3.0) and pain relief rate (PAR) before treatment and 2 weeks after treatment. [Results] The total remission rate of cancer pain was 85.3% in the combination group and 77.8% in the control group, with no significant difference (P> 0.05). After 2 weeks of treatment, the average dose of oxocorticine in the combination group was 53 ± 36.9 ) mg, and the mean dose of Oxycodin in the control group was (70 ± 50.4) mg. The regression analysis showed that depression in cancer pain patients was influenced by age, marital status, type of health care and pain scores. Before treatment Depression, no significant difference in depression, after 2 weeks of treatment, the depression of the combination group was more obvious; the quality of life of patients with cancer pain was generally poor. After 2 weeks of treatment, the overall quality of life, body function, role function, emotional function, Function were better than before treatment, the combination therapy group in the emotional and social functions in two dimensions was significantly better than the control group. [Conclusion] Opioid combined with morphine titration can achieve a good analgesic effect. Patients with cancer pain accompanied by moderate and severe depression, combined with antidepressants, can significantly improve depression, obtain better analgesic effect and improve the patients’ Quality of Life.