加巴喷丁联合阿米替林治疗阿片耐受的重度癌痛的临床回顾性研究

何迎盈; 陈兆红; 赵雷; 范习刚

doi:10.16016/j.1000-5404.201704117

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加巴喷丁联合阿米替林治疗阿片耐受的重度癌痛的临床回顾性研究

临床医学 | 更新时间：2026-01-09

- 加巴喷丁联合阿米替林治疗阿片耐受的重度癌痛的临床回顾性研究
- Clinical efficacy of gabapentin combined with amitriptyline in patients with opioid tolerance and severe cancer pain:a retrospective study
- 第三军医大学学报 2017年39卷第19期页码：1939-1943
- 作者机构：
  
  618000 四川德阳，德阳市人民医院肿瘤科
- 作者简介：
  
  [ 何迎盈，E-mail：729334324@qq.com HE Yingying, E-mail:729334324@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201704117
  中图分类号： R181.32;R735.2;R971.3
- 收稿：2017-04-24，
  
  修回：2017-07-18，
  
  纸质出版：2017-10-15
- 稿件说明：
移动端阅览
何迎盈, 陈兆红, 赵雷, 等. 加巴喷丁联合阿米替林治疗阿片耐受的重度癌痛的临床回顾性研究[J]. 第三军医大学学报, 2017,39(19):1939-1943.

Yingying HE, Zhaohong CHEN, Lei ZHAO, et al. Clinical efficacy of gabapentin combined with amitriptyline in patients with opioid tolerance and severe cancer pain:a retrospective study[J]. Journal of Third Military Medical University, 2017, 39(19): 1939-1943.
何迎盈, 陈兆红, 赵雷, 等. 加巴喷丁联合阿米替林治疗阿片耐受的重度癌痛的临床回顾性研究[J]. 第三军医大学学报, 2017,39(19):1939-1943. DOI： 10.16016/j.1000-5404.201704117.

Yingying HE, Zhaohong CHEN, Lei ZHAO, et al. Clinical efficacy of gabapentin combined with amitriptyline in patients with opioid tolerance and severe cancer pain:a retrospective study[J]. Journal of Third Military Medical University, 2017, 39(19): 1939-1943. DOI： 10.16016/j.1000-5404.201704117.

摘要

目的

通过回顾性研究，评价加巴喷丁联合阿米替林治疗阿片耐受(opioid tolerance)的重度癌痛(cancer pain)的临床疗效。

方法

以2015年9月至2016年9月间，德阳市人民医院肿瘤科诊断明确的仅能姑息对症治疗的阿片耐受的重度癌痛患者为研究对象。按接受的镇痛治疗方案分为两组，对照组29例：仅给予吗啡(吗啡缓释片、吗啡注射液)治疗；观察组28例：给予加巴喷丁、阿米替林及吗啡(吗啡缓释片、吗啡注射液)治疗。治疗目标为背景痛(background cancer pain)数字评分法(numberical rating scale，NRS)≤3分，两组患者均根据疼痛程度调整药物用量，当出现爆发痛(breakthrough pain

BTP)时采用盐酸吗啡注射液皮下注射。比较两组患者疼痛稳定后焦虑、抑郁、生存质量、日需吗啡量。

结果

① 焦虑、抑郁状态改善：与治疗前相比，两组患者焦虑、抑郁评分均下降(

0.05)，但观察组较对照组下降更明显(

0.05)；② 日需吗啡量：相比治疗前，疼痛控制稳定需要增加一定量的吗啡，但观察组增加量较对照组少(

0.05)；③ 生存质量：与治疗前相比，两组患者的躯体功能、角色功能及社会功能无明显改变(

0.05)，但情绪功能改善(

0.05)，对照组患者失眠、总健康较治疗前无明显改善(

0.05)，且恶心呕吐、便秘、食欲丧失较治疗前症状加重(

0.05)。观察组失眠、食欲丧失、总健康得到改善(

0.05)，恶心呕吐、便秘较治疗前无明显变化(

0.05)。

结论

加巴喷丁联合阿米替林不仅可增强吗啡对阿片耐受的重度癌痛的疼痛控制，且不增加恶心呕吐、便秘，还可以改善焦虑、抑郁、失眠和食欲丧失等症状，提高总健康评分。

Abstract

Objective

To determine the clinical efficacy of gabapentin combined with amitriptyline in the patients with opioid tolerance and severe cancer pain.

Methods

Clinical data of cancer patients with opioid tolerance and severe cancer pain who received palliative care treatment in our department from September 2015 to September 20

16 were collected and retrospectively analyzed in this study. They were divided into control group (

=29

morphine alone

morphine sustained release tablets and/or morphine injection) and observation group (

=28

gabapentin

amitriptyline and morphine sustained release tablets and/or morphine injection). The goal of pain relief was background cancer pain less than 3 points by numberical rating scale (NRS). The dosages of corresponding drugs were adjusted according to the severity of pain

and morphine hydrochloride injection was injected subcutaneously when breakthrough pain episodes appeared. Anxiety

depression

quality of life

and amount of morphine daily requirement were compared between the 2 groups after the condition became stable.

Results

① The scores of anxiety and depression were reduced in the both groups after the treatment (

0.05)

but the decreases were more significant in the observation group (

0.05). ② For the amount of morphine daily requirement

certain larger amount of morphine was needed for pain control than the amount before the treatment

but the observation group needed relatively less (

0.05). ③ Compared with the patients' conditions before treatment

there were no obvious changes in their physical

role and social functions in the both groups (

0.05)

but the emotional function had been improved (

0.05). However

insomnia and total body health had no obvious improvement in control group as compared to pre-treatment (

0.05)

and the symptoms such as nausea vomiting

constipation

and loss of appetite even worsened (

0.05). In the observation group

the symptoms of insomnia

loss of appetite and total body health were improved (

0.05)

while nausea

vomiting

and constipation had no significant changes (

0.05

Conclusion

Gabapentin combined with amitriptyline can enhance analgesic effect of morphine

induce no side effects

such as nausea

vomiting

and constipation

but improve the symptoms of anxiety

depression

insomnia and loss of appetite

and promote total body health in the patients with opioid tolerance and severe cancer pain.

关键词

Keywords

references

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