黄中+邵汛帆

[摘要]目的 通过对羟考酮止痛治疗时机的分析，探讨如何提高鼻咽癌IMRT同期放化疗患者放射性口腔黏膜炎的止痛效果。 方法 选取2012年1月～2014年3月我院收治的鼻咽癌患者102例，均给予相同的IMRT同期放化疗、营养干预及口腔护理等，采用视觉模拟评分法（VAS）对放化疗中口腔黏膜炎损伤疼痛进行评分，随机分为1、2、3组，1组患者轻度疼痛（1～3分）开始口服盐酸羟考酮缓释片；2组患者中度疼痛（4～6分）开始口服盐酸羟考酮缓释片；3组患者重度疼痛（7～9分）开始口服盐酸羟考酮缓释片；观察比较三组患者疼痛评分变化、生活质量改善、营养状况、平均止痛药物使用量以及药物不良反应等情况。 结果 在第7周放疗结束后，1组患者VAS评分和QOL评分均较2、3组具有明显差异（P<0.05），1组患者营养不良发生率及恶心呕吐、便秘、嗜睡、头晕头痛等药物不良反应发生率均显著少于2、3组，差异具有统计学意义（P<0.05），三组患者均未出现呼吸抑制等阿片类药物严重不良反应，1组患者人均止痛药物使用量显著少于2、3组，差异具有统计学意义（P<0.05）。 结论 鼻咽癌IMRT同期放化疗所致的口腔黏膜损伤疼痛患者，早期给予镇痛治疗，镇痛效果明显，药物不良反应少，患者营养状况良好，生活质量高，对提高放化疗治疗效果具有重要意义。

[关键词]鼻咽癌；IMRT；放射性口腔黏膜炎；羟考酮；疼痛

[中图分类号]R739.6 [文献标识码]A [文章编号]2095-0616（2013）20-27-04

Pain management of nasopharyngeal carcinoma with IMRT concurrent chemotherapy

HUANG Zhong SHAO Xunfan ZHENG Naiying

Department of the Third Radiotherapy，Tumor Hospital Affiliated Guangzhou Medical University，Guangzhou 510095，China

[Abstract]Objective Through the analysis of oxycodone pain treatment opportunity to investigate how to improve the analgesic effect of radioactive oral mucositis of NPC patients with IMRT concurrent chemotherapy. Methods 102 cases of patients with nasopharyngeal carcinoma from January 2012 to March 2014 treated in our hospital were selected，received the same IMRT concurrent chemoradiotherapy，nutrition interventions and oral care，chemotherapy injury pain in oral mucositis were scored according to the visual analog scale（VAS），were randomly divided into the first，second and third group，the first group of patients began to oral oxycodone zyban with mild pain（1 to 3 points）；The second group of patients began to oral oxycodone zyban with moderate pain（4-6 points）；The third group of patients started to oral oxycodone zyban with moderate to severe pain（7 to 9 points）；The changes in pain scores，improved quality of life，nutritional status，the average amount of pain medication and adverse drug reactions，etc between three groups of patients were observed and compared. Results After the first seven weeks long radiotherapy，the differences of VAS score and QOL scores of the first group compared with the second or third group were significant（P<0.05），the incidence of malnutrition，nausea，vomiting，constipation，drowsiness，dizziness，headache and other drugs reactions of the first group were significantly less than the second group and the third group，the difference was statistically significant（P<0.05），patients of three groups had no serious adverse effects such as respiratory depression as opioid analgesic drug used ，analgesic drug average usage amount of the first group was significantly less than the second or third group，with statistically significant difference（P<0.05）. Conclusion Patients with pain of nasopharyngeal IMRT concurrent chemoradiotherapy-induced oral mucosal injury， are given early analgesic treatment，the analgesic effect is obvious，less adverse drug reactions，patients with well nutrition，high quality of life，it improve the effect of radiotherapy and chemotherapy，which is of great important significance.endprint

[Key words]Nasopharyngeal carcinoma；IMRT；Radioactivity oral mucositis；Oxycodone；Pain

鼻咽癌是我国居民常见恶性肿瘤之一，放射治疗是鼻咽癌首选治疗方法，而放射性口腔黏膜炎是鼻咽癌放疗过程中最常见的并发症，常规放疗发生率可高达80%以上，适形调强放疗（IMRT）发生率几乎为100%[1]，相关研究资料证实放射性口腔黏膜炎会造成患者口咽疼痛，疼痛除为患者带来进食不便外，严重者甚至需要延缓或中断治疗，从而影响患者治疗效果和生活质量[2]，因此，为减轻鼻咽癌IMRT同期化疗患者疼痛，提高放化疗效果，改善患者生活质量，本次研究通过利用盐酸羟考酮治疗鼻咽癌IMRT同期化疗所致口腔黏膜疼痛，为临床用药治疗提供参考，现报道如下。……