王新亭 张传雷 陈晓琦 冀爱英 袁媛 陈欣菊

【摘要】 目的 观察三氧化二砷辅助治疗肝癌癌性疼痛的临床疗效。方法 将40例肝癌癌性疼痛患者随机分为观察组和对照组，每组20例，对照组给予吗啡缓释片口服治疗，观察组给予吗啡缓释片口服的同时给予三氧化二砷规律输注，14天为一疗程。观察两组患者VAS评分、吗啡缓释片用量、疼痛缓解持续时间、爆发痛次数及生存质量改善率。结果 观察组治疗14天后的VAS评分低于对照组，吗啡用量少于对照组，疼痛缓解持续时间较对照组长，爆发痛次数较对照组少，比较差异均有统计学意义（P<0.05或0.01）。观察组生存质量改善率为65%（13/20），对照组生存质量改善率为30%（6/20），两组比较差异有统计学意义（χ2=4.912，P=0.027），观察组生存质量改善率更高。三氧化二砷治疗不良反应率为20%（4/20），经对症治疗后好转，不影响持续治疗。结论 三氧化二砷联合吗啡缓释片能够有效缓解肝癌癌性疼痛，且缓解持续时间长，同时可以减少吗啡的用量及爆发痛的次数，改善患者的生存质量。

【关键词】 原发性肝癌；癌性疼痛；三氧化二砷

中图分类号：R735.7 文献标识码：A DOI：10.3969/j.issn.1003-1383.2018.03.016

【Abstract】 Objective To observe the clinical efficacy of arsenic trioxide in the adjuvant treatment of liver cancer.Methods 40 liver cancer patients with cancerous pain were randomly divided into observation group and control group，with 20 cases in each group. The control group were given morphine sustained release tablets orally. The observation group were given morphine sustained release tablets while regularly injecting arsenic trioxide，with 14 days as a course of treatment. VAS score，the dosage of morphine sustained release tablets，the duration of pain relief，the outbreaks of cancerous pain and the improvement rate of the quality of life were observed between the two groups. Results After 14 days of treatment，the VAS score of the observation group was lower than that of the control group，the dosage of morphine was less，the duration of pain relief was longer and the outbreaks of cancerous pain were less than those of the control group，difference was statistically significant（P<0.05 or 0.01）. The improvement rate of quality of life was 65% （13/20） in the observation group and 30% （6/20） in the control group，difference was statistically significant（χ2=4.912，P=0.027），the improvement rate of quality of life was higher in the observation group. The adverse reaction rate of arsenic trioxide treatment was 20% （4/20），which improved after symptomatic treatment，and did not affect continuous treatment.Conclusion Arsenic trioxide combined with morphine sustained release tablets can effectively relieve the pain of liver cancer for a long time. At the same time，it can reduce the dosage of morphine and the outbreaks of cancerous pain，and improve the quality of life of patients.

【Key words】 primary carcinoma of liver； cancerous pain； arsenic trioxide

原發性肝癌的发病率居我国恶性肿瘤的第三位，死亡率居第二位，为临床常见恶性肿瘤[1]。由于肝癌恶性程度高，早期临床症状表现不明显，因此许多肝癌患者临床确诊时已是中晚期，已失去了手术机会。中晚期肝癌患者常出现肝区、腹部剧烈的疼痛症状，癌性疼痛是此类患者最难以忍受的临床症状之一。研究显示，75%～95%的晚期癌症患者饱受着疼痛的折磨，癌性疼痛极大地影响患者的生活质量与预后[2]。临床广泛采用阿片类药物缓解此类患者的癌性疼痛[3]，而长期服用此类药物容易成瘾及耐受性，而且许多患者不能耐受其恶心、便秘、头晕等不良反应，甚至部分患者对单纯的镇痛药物耐受，镇痛效果并不理想。三氧化二砷俗称砒霜，自古就被中医药……