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盐酸氢吗啡酮治疗骨癌痛患者的临床效果及对疼痛相关介质和激素水平的影响
张生茂1      李娜2      包娜日素1      苏楠1      云乐天1      赵智慧1
1.内蒙古自治区人民医院麻醉科,内蒙古呼和浩特   010017;
2.呼和浩特市第一医院疼痛科,内蒙古呼和浩特   010017
Clinical effect of Hydromorphone Hydrochloride in the treatment of patients with bone cancer pain and its influence on pain related mediators and hormone levels#br#
ZHANG Shengmao1   LI Na2   BAO Narisu1   SU Nan1   YUN Letian1   ZHAO Zhihui1
1.Department of Anesthesiology, Inner Mongolia People’s Hospital, Inner Mongolia Autonomous Region, Huhhot   010017, China; 
2.Department of Pain Treatment, Hohhot First Hospital, Inner Mongolia Autonomous Region, Huhhot   010017, China
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摘要 目的 探讨盐酸氢吗啡酮对骨癌痛患者的镇痛效果及镇痛机制。 方法 收集2017年1月至2020年3月内蒙古自治区人民医院收治的50例骨癌痛患者。依据随机信封法分为对照组和观察组,每组25例。对照组采用静脉镇痛泵给予帕米磷酸二钠治疗,观察组采用静脉镇痛泵给予盐酸氢吗啡酮治疗。比较两组视觉模拟评分法(VAS)评分和卡氏功能状态(KPS)评分;检测两组治疗前,治疗后1、2、3个月血清疼痛介质[5-羟色胺(5-HT)、一氧化氮(NO)、前列腺素E(PGE2)]和应激激素[皮质醇(Cor)、生长激素(GH)、泌乳素(PRL)]表达水平;分析盐酸氢吗啡酮镇痛效果与骨癌痛患者血清疼痛介质及应激激素水平的相关性。 结果 观察组镇痛效果优于对照组(P < 0.05)。治疗1个月后,两组5-HT、NO、PGE2、Cor、GH、PRL水平低于治疗前(P < 0.05);治疗后2、3个月,两组5-HT、NO、PGE2、Cor、GH、PRL水平低于治疗后1个月(P < 0.05)。治疗后1、2、3个月,观察组5-HT、NO、PGE2、Cor、GH、PRL水平低于对照组(P < 0.05)。VAS评分与血清5-HT、NO、PGE2、Cor、GH、PRL水平呈负相关(r = -0.903、-0.675、-0.748、-0.706、-0.901、-0.621,P < 0.05);KPS评分与血清5-HT、NO、PGE2、Cor、GH、PRL水平呈负相关(r = -0.801、-0.696、-0.738、-0.629、-0.752、-0.763,P < 0.05)。 结论 盐酸氢吗啡酮对骨癌痛患者治疗效果优于传统镇痛药物,镇痛机制与抑制疼痛介质及应激激素水平有关。
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张生茂1 李娜2 包娜日素1 苏楠1 云乐天1 赵智慧1
关键词 骨癌痛盐酸氢吗啡酮帕米磷酸二钠疼痛介质应激激素    
Abstract:Objective To investigate the analgesic effect and mechanism of Hydromorphone Hydrochloride in patients with bone cancer pain. Methods A total of 50 patients with bone cancer pain admitted to Inner Mongolia People’s Hospital from January 2017 to March 2020 were collected. They were divided into control group and observation group by random envelope method, with 25 cases in each group. The control group was treated with Disodium Pamidronate by intravenous analgesia pump, and the observation group was treated with Hydromorphone Hydrochloride by intravenous analgesia pump. Visual analogue scale (VAS) score and Karnofsky performance status (KPS) score were compared between two groups; the expression levels of pain mediators (5-hydroxytryptamine [5-HT], nitric oxide [NO], prostagrandin E2 [PGE2]) and stress hormones (cortisol [Cor], growth hormone [GH], prolactin [PRL]) were detected before treatment and 1, 2, and 3 months after treatment; the correlation between analgesic effect of Hydromorphone Hydrochloride and the levels of serum pain mediators and stress hormones in patients with bone cancer pain were analyzed. Results The analgesic effect of observation group was better than control group (P < 0.05). After 1 month of treatment, the levels of 5-HT, NO, PGE2, Cor, GH, and PRL in both groups were lower than those before treatment (P < 0.05); after 2 and 3 months of treatment, the levels of 5-HT, NO, PGE2, Cor, GH, and PRL in both groups were lower than those after 1 month of treatment (P < 0.05). After 1, 2, and 3 months of treatment, the levels of 5-HT, NO, PGE2, Cor, GH, and PRL in observation group were lower than those in control group (P < 0.05). VAS score was negatively correlated with the levels of serum 5-HT, NO, PGE2, Cor, GH, and PRL (r = -0.903, -0.675, -0.748, -0.706, -0.901, -0.621, P < 0.05); KPS score was negatively correlated with the levels of serum 5-HT, NO, PGE2, Cor, GH, and PRL (r = -0.801, -0.696, -0.738, -0.629, -0.752, -0.763, P < 0.05). Conclusion The therapeutic effect of Hydromorphone Hydrochloride on patients with bone cancer pain is better than that of traditional analgesics. The analgesic mechanism is related to inhibit the pain mediators and stress hormone levels.
Key wordsBone cancer pain    Hydromorphone Hydrochloride    Disodium Palmiphosphate    Pain mediators    Stress hormone
    
基金资助:内蒙古自治区自然科学基金面上项目(2021MS 08109)。
通讯作者: 赵智慧(1976-),女,博士,主任医师;研究方向:临床麻醉。   
作者简介: 张生茂(1984-),男,硕士,副主任医师;研究方向:麻醉药物在骨癌痛中的应用。
引用本文:   
张生茂1 李娜2 包娜日素1 苏楠1 云乐天1 赵智慧1. 盐酸氢吗啡酮治疗骨癌痛患者的临床效果及对疼痛相关介质和激素水平的影响[J]. 中国医药导报, 2022, 19(1): 119-122,127.
ZHANG Shengmao1 LI Na2 BAO Narisu1 SU Nan1 YUN Letian1 ZHAO Zhihui1. Clinical effect of Hydromorphone Hydrochloride in the treatment of patients with bone cancer pain and its influence on pain related mediators and hormone levels#br#. 中国医药导报, 2022, 19(1): 119-122,127.
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