崔健 侯军君 黄丽 吴红 崔月倩 高勇 管林

【摘要】 目的：探討一种针对初治癌性神经病理性疼痛快速、有效的滴定策略。方法：选取2018年1月-2020年1月在某肿瘤专科医院初治的癌性神经病理性疼痛患者120例，按随机数字表法分为干预组和对照组，各60例。对照组应用盐酸吗啡片常规滴定，疼痛有效控制后改为羟考酮缓释片维持。干预组应用羟考酮缓释片联合加巴喷丁治疗。比较两组治疗第24、48、72小时及第1周时疼痛控制、负性情绪、睡眠质量改善情况及不良反应发生请况。结果：干预组治疗第24、48、72小时的疼痛控制率均高于对照组（P<0.05）。干预组治疗第24、48小时的焦虑情绪与睡眠质量改善率均高于对照组（P<0.05）。干预组治疗第24小时的抑郁情绪改善率高于对照组（P<0.05）。干预组恶心呕吐及便秘发生率均低于对照组（P<0.05）。结论：羟考酮为背景用药联合加巴喷丁滴定治疗初治癌性神经病理性疼痛可快速有效地控制患者疼痛、改善负性情绪及睡眠质量，且安全性好，值得临床推广。

【关键词】 羟考酮 加巴喷丁 癌性神经病理性疼痛 滴定

Clinical Study on Titration Strategy of Primary Malignant Neuropathic Pain/CUI Jian， HOU Junjun， HUANG Li， WU Hong， CUI Yueqian， GAO Yong， GUAN Lin. //Medical Innovation of China， 2021， 18（01）： 073-077

[Abstract] Objective： To explore a rapid and effective titration strategy for primary malignant neuropathic pain. Method： A total of 120 patients with malignant neuropathic pain initially treated in a specialized cancer hospital from January 2018 to January 2020 were selected. They were divided into intervention group and control group according to the random number table method， with 60 patients in each group. The control group was routinely titrated with Morphine Hydrochloride Tablets， and after the pain was effectively controlled， Oxycodone Sustained Release Tablets were used for maintenance. The intervention group was treated with Oxycodone Sustained Release Tablets combined with Gabapentin. Pain control， improvement of negative mood， sleep quality at 24， 48， 72 h and

1 week of treatment and adverse reactions were compared between the two groups. Result： The pain control rate at 24， 48 and 72 h of treatment in the intervention group were higher than those in the control group （P<0.05）. The anxiety and sleep quality improvement rates at 24 and 48 h of treatment in the intervention group were higher than those in the control group （P<0.05）. The improvement rate of depression at 24 h of treatment in the intervention group was higher than that in the control group （P<0.05）. The incidence of nausea， vomiting and constipation in the intervention group were lower than those in the control group （P<0.05）. Conclusion： Oxycodone as background drug combined with Gabapentine titration in the treatment of primary malignant neuropathic pain can rapidly and effectively control patients pain， improve negative mood and sleep quality， and is safe. which is worthy of clinical promotion.

[Key words] Oxycodone Gabapentin Malignant neuropathic pain Titration

First-authors address： Taian Tumor Prevention and Treatment Hospital， Taian 271000， China

doi：10.3969/j.issn.1674-4985.2021.01.019

神经病理性疼痛（neuropathic pain，NP）是由于躯体感觉系统的损伤或疾病引起的疼痛[1]。其中癌性神经病理性疼痛（malignant neuropathic pain，MNP）在肿瘤诊疗中较为常见，39%的癌痛患者伴有神经病理性疼痛[2]。其病因较为复杂，肿瘤侵犯神经、某些具有神经毒性的化疗药物、手术及放疗损伤均可导致[3]。中国卫生健康委员会癌痛诊疗规范及美国综合癌症网络（NCCN）指南均推荐伴有神经病理性疼痛的癌痛患者可辅助使用抗抑郁药、抗惊厥药进行治疗[4-5]。加巴喷丁作为新一代抗惊厥药，可通过抑制感觉神经的过度电冲动发挥镇痛作用，对神经性疼痛有较好的治疗效果，且能明显降低神经病理性癌痛者阿片耐受指数[6-9]。相关研究显示阿片类药物联合加巴喷丁治疗中重度癌痛患者疗效确切，在老年癌性神经病理性疼痛治疗中也有着良好的效果及安全性[10-12]。……