CAJ | 학술논문

目的：通过对羟考酮止痛治疗时机的分析，探讨如何提高鼻咽癌IMRT同期放化疗患者放射性口腔黏膜炎的止痛效果。方法选取2012年1月～2014年3月我院收治的鼻咽癌患者102例，均给予相同的IMRT同期放化疗、营养干预及口腔护理等，采用视觉模拟评分法（VAS）对放化疗中口腔黏膜炎损伤疼痛进行评分，随机分为1、2、3组，1组患者轻度疼痛（1～3分）开始口服盐酸羟考酮缓释片；2组患者中度疼痛（4～6分）开始口服盐酸羟考酮缓释片；3组患者重度疼痛（7～9分）开始口服盐酸羟考酮缓释片；观察比较三组患者疼痛评分变化、生活质量改善、营养状况、平均止痛药物使用量以及药物不良反应等情况。结果在第7周放疗结束后，1组患者VAS评分和QOL评分均较2、3组具有明显差异（P＜0.05），1组患者营养不良发生率及恶心呕吐、便秘、嗜睡、头晕头痛等药物不良反应发生率均显著少于2、3组，差异具有统计学意义（P＜0.05），三组患者均未出现呼吸抑制等阿片类药物严重不良反应，1组患者人均止痛药物使用量显著少于2、3组，差异具有统计学意义（P＜0.05）。结论鼻咽癌IMRT同期放化疗所致的口腔黏膜损伤疼痛患者，早期给予镇痛治疗，镇痛效果明显，药物不良反应少，患者营养状况良好，生活质量高，对提高放化疗治疗效果具有重要意义。
목적：통과대간고동지통치료시궤적분석，탐토여하제고비인암IMRT동기방화료환자방사성구강점막염적지통효과。방법선취2012년1월～2014년3월아원수치적비인암환자102례，균급여상동적IMRT동기방화료、영양간예급구강호리등，채용시각모의평분법（VAS）대방화료중구강점막염손상동통진행평분，수궤분위1、2、3조，1조환자경도동통（1～3분）개시구복염산간고동완석편；2조환자중도동통（4～6분）개시구복염산간고동완석편；3조환자중도동통（7～9분）개시구복염산간고동완석편；관찰비교삼조환자동통평분변화、생활질량개선、영양상황、평균지통약물사용량이급약물불량반응등정황。결과재제7주방료결속후，1조환자VAS평분화QOL평분균교2、3조구유명현차이（P＜0.05），1조환자영양불량발생솔급악심구토、편비、기수、두훈두통등약물불량반응발생솔균현저소우2、3조，차이구유통계학의의（P＜0.05），삼조환자균미출현호흡억제등아편류약물엄중불량반응，1조환자인균지통약물사용량현저소우2、3조，차이구유통계학의의（P＜0.05）。결론비인암IMRT동기방화료소치적구강점막손상동통환자，조기급여진통치료，진통효과명현，약물불량반응소，환자영양상황량호，생활질량고，대제고방화료치료효과구유중요의의。
Objective Through the analysis of oxycodone pain treatment opportunity to investigate how to improve the analgesic effect of radioactive oral mucositis of NPC patients with IMRT concurrent chemotherapy. Methods 102 cases of patients with nasopharyngeal carcinoma from January 2012 to March 2014 treated in our hospital were selected,received the same IMRT concurrent chemoradiotherapy,nutrition interventions and oral care,chemotherapy injury pain in oral mucositis were scored according to the visual analog scale(VAS),were randomly divided into the first,second and third group,the first group of patients began to oral oxycodone zyban with mild pain(1 to 3 points);The second group of patients began to oral oxycodone zyban with moderate pain(4-6 points);The third group of patients started to oral oxycodone zyban with moderate to severe pain(7 to 9 points);The changes in pain scores,improved quality of life,nutritional status,the average amount of pain medication and adverse drug reactions,etc between three groups of patients were observed and compared. Results After the first seven weeks long radiotherapy,the differences of VAS score and QOL scores of the first group compared with the second or third group were significant(P<0.05),the incidence of malnutrition,nausea,vomiting,constipation,drowsiness,dizziness,headache and other drugs reactions of the first group were significantly less than the second group and the third group,the difference was statistically significant(P<0.05),patients of three groups had no serious adverse effects such as respiratory depression as opioid analgesic drug used ,analgesic drug average usage amount of the first group was significantly less than the second or third group,with statistically significant difference(P < 0.05). Conclusion Patients with pain of nasopharyngeal IMRT concurrent chemoradiotherapy-induced oral mucosal injury, are given early analgesic treatment,the analgesic effect is obvious,less adverse drug reactions,patients with well nutrition,high quality of life,it improve the effect of radiotherapy and chemotherapy,which is of great important significance.