摘要
目的探讨非甾体类抗炎药(NSAIDs)对肿瘤骨转移患者闪烁痛的疗效。方法回顾性分析2016年1月1日至2020年6月30日就诊于重庆医科大学附属第一医院及重庆医科大学附属第二医院的322例行^(89)SrCl_(2)治疗的骨转移瘤患者病历资料。322例患者均曾接受药物镇痛、外照射治疗且效果较差或无效。原发肿瘤均由病理证实,骨转移灶均根据CT、MRI、ECT或骨组织活检明确诊断。322例患者中,使用^(89)SrCl_(2)治疗后第1周出现闪烁痛的患者共28例,服用NSAIDs止痛(NSAIDs组)患者共16例,使用阿片类药物止痛(Opiates组)患者共12例,统计并分析两组患者^(89)SrCl_(2)治疗前1 d、治疗后1 d、治疗后3 d、治疗后1周、治疗后1个月及治疗后2个月的主诉疼痛分级标准(VRS)评分及KPS评分变化情况。结果出现闪烁痛现象患者中,使用NSAIDs止痛与使用阿片类药物止痛两组患者的性别、年龄、影像学确诊方法、治疗前VRS评分、治疗前KPS评分差异均无统计学意义(P>0.05)。两组患者均于^(89)SrCl_(2)治疗后第3天左右出现闪烁痛现象,分别予以NSAIDs及阿片类药物对症止痛后,疼痛均于第7天左右不同程度缓解。两组患者^(89)SrCl_(2)治疗后1周VRS评分(P=0.019)及KPS评分(P=0.032)差异有统计学意义,而治疗前1 d、治疗后1 d、治疗后3 d、治疗后1个月及治疗后2个月的VRS评分及KPS评分比较差异均无统计学意义(P>0.05)。此外,NSAIDs组患者治疗后1周与治疗前1 d VRS评分降低数值(χ^(2)=11.264,P=0.024)及KPS评分增加数值(χ^(2)=9.888,P=0.042)与Opiates组比较,差异有统计学意义。两组患者VRS及KPS纵列散点图及频数点图可见,NSAIDs较阿片类药物对于该类患者疗效更好,且不增加相关不良反应(χ^(2)=0.312,P=0.577)。结论NSAIDs较阿片类药物可更好地缓解^(89)SrCl_(2)治疗肿瘤骨转移所致骨痛后出现的闪烁痛现象,可成为该类患者的一种补充治疗手段。
Objective To retrospectively analyze the efficacy of non-steroidal antiinflammatory drugs(NSAIDS)in treating painflare of the patients with tumor bone metastasis.Methods The case data of 322 patients with bone metastatic tumor treated with ^(89)SrCl_(2) in the First Affiliated Hospital and Second Affiliated Hospital of Chongqing Medical University from January 1,2018 to June 30,2020 were retrospective analyzed.All 322 cases received the medication analgesia and external irradiation treatment with poor or ineffective effect.The primary tumors were confirmed by pathology,and the bone metastases focuses were definitely diagnosed by CT,MRI,ECT or bone biopsy.Among 322 cases,28 cases appeared painflare in the first week after treatment with ^(89)SrCl_(2),16 cases took NSAIDs(NSAIDs group)for analgesia,and 12 cases took opiates(opiates group)for analgesia.The changes of VRS score and KPS score in the two groups were statistically analyzed on 1 d before^(89)SrCl_(2) treatment,on 1,3 d,in 1 week,1 month and 2 months after ^(89)SrCl_(2) treatment.Results Among the cases of painflare,there were no statistically significant differences in gender,age,imaging diagnosis method,VRS score before treatment and KPS score before treatment between the groups receiving NSAIDs and Opiates for analgesia(P>0.05).The painflare in both groups occurred on 3 d after treatment of ^(89)SrCl_(2),the pain was alleviated to different degrees on about 7 d after giving NSAIDs and Opiates.The difference of VRS score(P=0.019)and KPS score(P=0.032)in1 week after ^(89)SrCl_(2) treatment were statistically significant.While the changes of VRS score and KPS score in the two groups had no statistical difference(P>0.05)on 1 d before treatment,on 1,3 d after treatment,in 1 week,1,2 months after treatment of ^(89)SrCl_(2).In addition,there were significant differences in the VRS scores reduce numeric value(χ^(2)=11.264,P=0.024)and KPS scores increase numeric value(χ^(2)=9.888,P=0.042)in 1 week after treatment and on 1 d before treatment between the two groups.The vertical scatter plot and frequency plot of VRS score and KPS score in the two groups showed that NSAIDs was more effective than Opiates in these patients,moreover without increasing the related adverse reactions(χ^(2)=0.312,P=0.577).Conclusion NSAIDs can better alleviate the painflare after the treatment of ^(89)SrCl_(2) in the patients of bone pain caused by tumor bone metastasis than opiates,which could become a supplementary treatment means for these patients.
作者
唐翠萍
曾维威
夏蕾
杨镇洲
王倩滢
黄玉胜
TANG Cuiping;ZENG Weiwei;XIA Lei;YANG Zhenzhou;WANG Qianying;HUANG Yusheng(Department of Oncology,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Otorhinolaryngology,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《重庆医学》
CAS
2022年第9期1468-1472,共5页
Chongqing medicine
基金
重庆市科卫联合医学科研项目(2019MSXM024)。
作者简介
唐翠萍(1991-),住院医师,硕士,主要从事肿瘤综合治疗研究;通信作者:黄玉胜,E-mail:304659@hospital.cqmu.edu.cn。
