柴胡疏肝散辅助芬太尼透皮贴治疗肝癌疼痛

摘要

Objective:To study the effect of Chaihushugansan in combination with fentanyl transdermal system on pain of liver cancer patients in a randomized and double-blind trail. Methods:Fifty patients with terminal liver cancer and pain were divided into the observing group and the control group, each 25 cases. The observing group was administered by fentanyl transdermal system 4. 2 mg once every 72 hours and Chaihushugansan every day while the control group also by fentanyl transdermal system and placebo in the beginning. Morphine injection was used to relieve breakthrough pain. Pain grades were noted with numerical rating scale. The dose of fentanyl transdermal system was added with the aim of relieving pain completely or obviously. The states of pain, doses of fentanyl transdermal system, adverse reactions were evaluated after 21 days. Results:Pain grades of the two groups were decreased obviously after therapy. The remission rates of pain and adverse reactions of two groups were statistically insignificant ( P > 0. 05 ) . Compared with the control group, the average dose of fentanyl transdermal system of the observing group was less and statistically significant ( P < 0. 05) . Conclusion:Fentanyl transdermal system can alleviate pain of liver cancer patients. Chaihushugansan can reduce the dose of fentanyl transdermal system in treating pain of liver cancer patients.%目的:随机双盲法观察柴胡疏肝散辅助芬太尼透皮贴治疗肝癌疼痛的效果.方法:50例晚期肝癌伴疼痛患者随机分为观察组和对照组,每组25例.观察组患者开始每72小时外用芬太尼透皮贴4.2mg(25 μg/h)1张,每日给予中药疏肝理气的代表方剂柴胡疏肝散口服；对照组患者开始每72小时外用芬太尼透皮贴4.2mg(25 μg/h)1张,每日给予中药安慰剂口服.以吗啡注射液皮下注射治疗爆发痛.用数字疼痛评估法(NRS)记录疼痛评分,根据前24小时阿片类药物总量计算并增加芬太尼透皮贴剂量；连续用药并观察21天,评价两组患者疼痛评分、疼痛缓解率、芬太尼透皮贴使用剂量、不良反应.结果:治疗后两组疼痛评分均较治疗前明显下降(P＜0.01),治疗后两组间癌痛缓解率、疼痛评分及不良反应均无统计学差异(P＞0.05)；芬太尼透皮贴平均使用剂量分别为观察组(68.18±25.80) μg/h、对照组(89.13±37.56) g/h,两组有统计学差异(P＜0.05).结论:芬太尼透皮贴能有效治疗肝癌疼痛；柴胡疏肝散能减少芬太尼透皮贴治疗晚期肝癌疼痛的剂量.