米氮平联合芬太尼透皮贴治疗癌痛 伴抑郁状态的临床疗效

Changes of transdermal fentanyl dose and morphine dose for burst pain in the patients with cancer pain and depression state treated with mirtazapine

摘要:

目的 探讨米氮平联合芬太尼透皮贴治疗癌痛伴抑郁状态患者的临床疗效。方法 选取2017 年 1 月—2018 年1 月中国医科大学附属盛京医院疼痛科收治的癌痛伴抑郁状态患者96 例，随机分成治疗组46 例， 对照组50 例，治疗组给予芬太尼透皮贴联合米氮平15 mg 睡前口服，1 次/d ；对照组仅给予芬太尼透皮贴剂 镇痛治疗。分别记录治疗前、治疗1 周及治疗1 个月疼痛数字评分法后（NRS）评分、芬太尼透皮贴剂量及 吗啡补救镇痛药物剂量的变化。结果 不同时间点的NRS 评分及吗啡突发痛需求剂量比较，差异有统计学意 义（P <0.05）；两组患者NRS 评分、芬太尼需求剂量及吗啡突发痛需求剂量比较，差异无统计学意义（P >0.05）； 两组患者的芬太尼、吗啡突发痛需求剂量变化趋势比较，差异有统计学意义（P <0.05）。治疗1 个月后，两 组HAMD 评分较治疗前下降（P <0.05）；治疗组HAMD 评分较对照组下降（P <0.05）。结论 米氮平联 合芬太尼透皮贴治疗癌痛抑郁状态患者可显著缓解患者疼痛，与单纯使用芬太尼透皮贴相比，需要更少的 芬太尼贴剂量及吗啡补救镇痛药物剂量，不仅延缓了吗啡药物耐药性出现，还提高了患者镇痛满意度及依 从性。

Abstract:

Objective To investigate the clinical effect of mirtazapine combined with transdermal fentanyl in the patients with cancer pain and depression state. Methods ninety-six patients with cancer pain and depression state were selected, then randomly divided into treatment group (transdermal fentanyl combined with mirtazapine 15mg, n = 46) and control group (transdermal fentanyl, n = 50). numeric rating scale (NRS), transdermal fentanyl dose, morphine dose for burst pain and side effects were evaluated before treatment, 1 week and 1 month after treatment. Results There was a difference in NRS score and morphine dosage for burst pain at different time point (P < 0.05). There was no difference in the NRS, transdermal fentanyl dose and morphine dosage for burst pain between the treatment group and control group (P > 0.05). There was a difference in the trend of transdermal fentanyl dose and morphine dosage for burst pain in the treatment group and control group (P < 0.05). The HAMD score of both groups decreased after treatment, which were more significant in the treatment group than that in control group one month after treatment (P < 0.05). Conclusions Mirtazapine combined with transdermal fentanyl is more effective in patients with cancer pain and depression state. Compared with using transdermal fentanyl only, combined therapy is helpful for reducing the dose of opioids, delaying the time of drug resistance and improving patient’s satisfaction and compliance.