度洛西汀联合盐酸羟考酮对晚期癌性疼痛患者的疗效及焦虑抑郁情绪的影响

Efficacy of duloxetine combined with oxycodone in patients with advanced cancer pain and its effect on anxiety and depression

摘要:

目的 探讨度洛西汀联合盐酸羟考酮对晚期癌性疼痛患者的疗效及焦虑抑郁情绪的影响。方法 选取2018年3月—2021年10月南通大学附属南通肿瘤医院收治的82例晚期癌痛患者作为研究对象。将患者分为对照组、研究组，各41例。对照组口服羟考酮治疗，研究组在对照组的基础上加用度洛西汀，两组均持续治疗4周后观察疗效。统计两组羟考酮人均日口服剂量，比较两组治疗前后疼痛评分、疼痛相关因子变化及焦虑抑郁状况，比较两组治疗前后神经递质表达状况，观察药物安全性。结果 研究组羟考酮人均日口服剂量低于对照组（P <0.05）。研究组与对照组治疗前、治疗2周后、治疗4周后静息状态下的BPI评分比较，经重复测量设计的方差分析，结果 ①不同时间点的BPI评分有差异（P <0.05）；②两组静息状态下BPI评分有差异（P <0.05），研究组治疗后较对照组低，相对镇痛效果较好；③两组BPI评分变化趋势有差异（P <0.05）。研究组与对照组治疗前、治疗2周后、治疗4周后的PEG2、SP比较，经重复测量设计的方差分析，结果 ①不同时间点的PEG2、SP有差异（P <0.05）；②两组PEG2、SP有差异（P <0.05），研究组治疗后较对照组低，相对镇痛效果较好；③两组PEG2、SP变化趋势有差异（P <0.05）。研究组与对照组治疗前、治疗2周后、治疗4周后的HADS评分比较，经重复测量设计的方差分析，结果 ①不同时间点的HADS评分有差异（P <0.05）；②两组HADS评分有差异（P <0.05），研究组较对照组低；③两组HADS评分变化趋势有差异（P <0.05）。研究组与对照组治疗前、治疗2周后、治疗4周后的NE、5-HT比较，经重复测量设计的方差分析，结果 ①不同时间点的NE、5-HT有差异（P <0.05）；②两组NE、5-HT有差异（P <0.05），研究组治疗后较对照组高；③两组NE、5-HT变化趋势有差异（P <0.05）。两组不良反应率比较，差异无统计学意义（P >0.05）。结论 度洛西汀联合盐酸羟考酮可减轻晚期癌性疼痛患者疼痛，降低羟考酮用量及疼痛相关因子水平，改善焦虑抑郁情绪，上调神经递质表达，且安全性良好。

Abstract:

Objective To explore the efficacy of duloxetine combined with oxycodone in patients with advanced cancer pain and its effect on anxiety and depression.Methods A total of 82 patients with advanced cancer pain admitted to our hospital from March 2018 to October 2021 were selected. They were divided into control and study groups, with 41 cases in each group. The control group was treated with oxycodone, and the study group was treated with duloxetine on the basis of oxycodone. The therapeutic efficacy of both groups was observed after continuous treatments for 4 weeks. The daily oral dose of oxycodone per capita in the two groups was counted. The changes in pain scores and pain-related factors, and anxiety and depression before and after the treatment were compared between the two groups. The expressions of neurotransmitters before and after the treatment in the two groups were detected, and the drug safety during the treatment period was observed.Results The daily oral dose of oxycodone per capita in the study group was lower than that in the control group (P < 0.05). The Brief Pain Inventory (BPI) scores measured at rest before the treatment, after 2 weeks of the treatment, and after 4 weeks of the treatment were compared between the study group and the control group via repeated measures ANOVA, and the results revealed that there were differences in the BPI scores among different time points (P < 0.05) and between the study group and the control group (P < 0.05). Specifically, the BPI score of the study group was lower than that of the control group after the treatment (P < 0.05), indicating better analgesic effects. Besides, the change trends of the BPI scores were different between the study group and the control group (P < 0.05). The levels of prostaglandin E2 (PEG2) and substance P (SP) in the study group and the control group were compared before the treatment, after 2 weeks of the treatment, and after 4 weeks of the treatment via repeated measures ANOVA. The results demonstrated that there were differences in levels of PEG2 and SP among different time points (P < 0.05) and between the two groups (P < 0.05), and that the levels of PEG2 and SP in the study group were lower than those in the control group (P < 0.05), which suggested better analgesic effects. The change trends of levels of PEG2 and SP were also different between the study group and the control group (P <0.05). The Hospital Anxiety and Depression Scale (HADS) scores of the study group and the control group were compared before the treatment, after 2 weeks of the treatment, and after 4 weeks of the treatment via repeated measures ANOVA, showing that the HADS scores were different among the time points (P < 0.05) and between the groups (P < 0.05), and that the HADS score of the study group was lower than that of the control group (P < 0.05). The change trend of the HADS score between the study group and the control group was also different (P < 0.05). The levels of norepinephrine (NE) and 5-hydroxytryptamine (5-HT) of the study group and the control group were compared before the treatment, after 2 weeks of the treatment, and after 4 weeks of the treatment via repeated measures ANOVA. The results exhibited that there were differences in levels of NE and 5-HT at different time points (P < 0.05) and between the two groups (P < 0.05), and that the levels of NE and 5-HT in the study group were higher than those in the control group after the treatment (P < 0.05). The change trends of levels of NE and 5-HT between the study group and the control group were different (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusions Duloxetine combined with oxycodone may alleviate the pain in patients with advanced cancer pain. Besides, it reduces the dosage of oxycodone and the level of pain-related factors, improves anxiety and depression, and up-regulates the expressions of neurotransmitters with few safety concerns.