CAJ | 학술논문

目的：探讨芬太尼贴联合加巴喷丁治疗癌性神经病理性疼痛的临床疗效。方法：选择确诊为癌性神经病理性疼痛患者60例，随机分为单纯芬太尼贴治疗组（对照组）与芬太尼贴联合加巴喷丁组（联合组）。对照组对以前用过强阿片类药物的患者根据用药情况进行剂量转换，逐渐增量，直至疼痛缓解VAS<3分或爆发痛<3次；联合组在使用芬太尼贴的基础上加用加巴喷丁，初始剂量为100 mg 3次/日，逐渐增加剂量，直至疼痛缓解，但总用量≤2400 mg/日。观察治疗前、治疗后1、2、3和4W的VAS评分、生活质量评分（QOL）、疼痛缓解程度、阿片类药物的使用量及不良反应。结果：治疗后对照组与联合组VAS评分均有下降（P<0.05），联合组更明显（P<0.05）；QOL两组较治疗前均有改善（P<0.05），联合组改善显著（P<0.05）；对照组总有效率为83.3%，联合组为96.7%；联合组阿片类药物使用量较对照组明显减少，药物的不良反应明显降低P<0.05）。结论：芬太尼贴联合加巴喷丁治疗癌性神经病理性疼痛疗效显著，安全性高，不良反应低，值得临床推广。
목적：탐토분태니첩연합가파분정치료암성신경병이성동통적림상료효。방법：선택학진위암성신경병이성동통환자60례，수궤분위단순분태니첩치료조（대조조）여분태니첩연합가파분정조（연합조）。대조조대이전용과강아편류약물적환자근거용약정황진행제량전환，축점증량，직지동통완해VAS<3분혹폭발통<3차；연합조재사용분태니첩적기출상가용가파분정，초시제량위100 mg 3차/일，축점증가제량，직지동통완해，단총용량≤2400 mg/일。관찰치료전、치료후1、2、3화4W적VAS평분、생활질량평분（QOL）、동통완해정도、아편류약물적사용량급불량반응。결과：치료후대조조여연합조VAS평분균유하강（P<0.05），연합조경명현（P<0.05）；QOL량조교치료전균유개선（P<0.05），연합조개선현저（P<0.05）；대조조총유효솔위83.3%，연합조위96.7%；연합조아편류약물사용량교대조조명현감소，약물적불량반응명현강저P<0.05）。결론：분태니첩연합가파분정치료암성신경병이성동통료효현저，안전성고，불량반응저，치득림상추엄。
Objective:To observe the effect of transdermal fentanyl combined with gabapentin for the treatment of malignant neu-ropathic pain (MNP). Methods:A total of 60 patients with MNP were randomly divided into two groups. A total of 30 cases in the con-trol group received transdermal fentanyl according to the dosages of opioid medicine that patients used. Such dosages were gradually in-creased until the pain relief visual analogue scale (VAS) fell below 3 or until the times of breakthrough pain became less than 3. For the combined group, gabapentin was co-administered with transdermal fentanyl, similar to the control group. Initially, 100 mg of gabapen-tin was administered thrice a day. This dosage was gradually increased until pain relief. However, gabapentin dosages were kept below 2,400 mg a day. VAS, quality of life (QOL), degree of pain relief, dosages of fentanyl and morphine, and side effects were evaluated be-fore treatment and at one, two, three, and four weeks after the treatment. Results:Both groups exhibited lower VAS after treatment (P<0.05), but the difference was observed to be more significant in the combined group than that in the control group (P<0.05). Both groups exhibited improved QOL (P<0.05), which was observed to be more significant in the combined group than in the control group (P<0.05). The effective rate was 96.7%in the combined group and 83.3%in the control group. The dosage of opioid medicine and the side effects in the combined group were less than those in the control group. Conclusion:Transdermal fentanyl combined with gabapen-tin is effective for the treatment of malignant neuropathic pain.