穴位注射高乌甲素联合针刺治疗肺癌化疗患者癌性疼痛及对疼痛介质水平的影响

doi:10.3760/cma.j.cn441417-20250208-15003

摘要/Abstract

摘要：

目的　探讨穴位注射高乌甲素联合针刺治疗肺癌化疗患者癌性疼痛及对疼痛介质水平的影响。方法　本文为前瞻性研究。选取2021年6月至2024年6月在延安市中医医院进行化疗的176例肺癌患者为研究对象，采用随机数字表法分为常规组、针刺组、注射组、联合组，各44例。常规组男29例，女15例，年龄（57.52±9.05）岁，疼痛病程（21.18±4.14）d；针刺组男27例，女17例，年龄（59.02±8.63）岁，疼痛病程（21.84±4.03）d；注射组男28例，女16例，年龄（58.48±8.91）岁，疼痛病程（21.57±4.25）d；联合组男25例，女19例，年龄（56.91±9.24）岁，疼痛病程（20.32±4.09）d。4组均采用癌痛三阶梯止痛方案进行治疗。在此基础上，针刺组加用针刺治疗，注射组加用穴位注射高乌甲素治疗，联合组加用针刺联合穴位注射高乌甲素治疗。共治疗4个疗程。比较治疗前后癌性疼痛程度、睡眠质量、疼痛介质水平、生活质量及治疗后疼痛缓解情况。统计学方法采用单因素方差分析、χ²检验、t检验。结果　治疗后，联合组的视觉模拟评分法和匹兹堡睡眠质量指数评分均低于常规组、针刺组、注射组［（1.05±0.31）分比（2.52±0.44、1.75±0.41、1.59±0.39）分和（5.14±1.48）分比（9.05±2.29、6.73±2.06、6.50±2.03）分］，联合组的疼痛缓解总有效率均高于常规组、针刺组、注射组［97.73%（43/44）比75.00%（33/44）、84.09%（37/44）、84.09%（37/44）］，差异均有统计学意义（均P<0.05）；联合组的血清5-羟色胺、前列腺素E₂、P物质水平和欧洲癌症研究与治疗组织生活质量核心量表（EORTC-QLQ-C30）中的症状量表、单项测试题目评分均低于常规组、针刺组、注射组，针刺组、注射组均低于常规组（均P<0.05）；联合组的血清β内啡肽水平和EORTC-QLQ-C30中的功能量表、整体生活质量量表评分均高于常规组、针刺组、注射组，针刺组、注射组均高于常规组（均P<0.05）。结论　穴位注射高乌甲素联合针刺治疗能明显减轻肺癌化疗患者的癌性疼痛、调节疼痛介质水平，提升睡眠和生活质量。

关键词:

肺癌, 癌性疼痛, 高乌甲素, 针刺, 疼痛介质

Abstract:

Objective　To explore the effect of acupoint injection of lappaconitine combined with acupuncture in the treatment of cancer-related pain in lung cancer chemotherapy patients and pain mediator levels. Methods　This is a prospective study. A total of 176 lung cancer patients receiving chemotherapy at Yan'an Traditional Chinese Medicine Hospital from June 2021 to June 2024 were selected as study subjects. They were randomly divided into four groups: conventional group, acupuncture group, injection group, and combined group, with 44 cases in each group. In the conventional group, there were 29 males and 15 females, aged (57.52±9.05) years and a pain duration of (21.18±4.14) days; in the acupuncture group, there were 27 males and 17 females, aged (59.02±8.63) years and a pain duration of (21.84±4.03) days; in the injection group, there were 28 males and 16 females, aged (58.48±8.91) years and a pain duration of (21.57±4.25) days; in the combined group, there were 25 males and 19 females, aged (56.91±9.24) years and a pain duration of (20.32±4.09) days. All four groups received a three-step analgesic regimen for cancer pain. Additionally, the acupuncture group received acupuncture treatment, the injection group received acupoint injection of lappaconitine, and the combined group received both acupuncture and acupoint injection of lappaconitine. A total of four treatment cycles were conducted. The levels of cancer-related pain, sleep quality, pain mediator levels, quality of life, and pain relief after treatment were compared. Statistical methods included one-way ANOVA, χ² test, and t test. Results　After treatment, the visual analogue scale (VAS) scores and Pittsburgh Sleep Quality Index (PSQI) scores in the combined group were lower than those in the conventional group, acupuncture group, and injection group [(1.05±0.31) points vs. (2.52±0.44, 1.75±0.41, 1.59±0.39) points and (5.14±1.48) points vs. (9.05±2.29, 6.73±2.06, 6.50±2.03) points], with all differences being statistically significant (all P<0.05). The overall effective rate of pain relief in the combined group was higher than in the conventional group, acupuncture group, and injection group [97.73% (43/44) vs. 75.00% (33/44), 84.09% (37/44), 84.09% (37/44)], with significant differences (all P<0.05). Serum levels of serotonin, prostaglandin E₂, and substance P, as well as symptom scale scores and individual item scores from the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC-QLQ-C30), were lower in the combined group compared to the conventional group, acupuncture group, and injection group, while both the acupuncture and injection groups were lower than the conventional group (all P<0.05). Serum levels of β-endorphin and scores on the functional scale and overall quality of life scale from the EORTC-QLQ-C30 in the combined group were higher than those in the conventional group, acupuncture group, and injection group, with both the acupuncture and injection groups being higher than the conventional group (all P<0.05). Conclusion　Acupoint injection of lappaconitine combined with acupuncture in the treatment of lung cancer chemotherapy patients can significantly alleviate cancer-related pain, reduce pain mediator levels and improve sleep quality and quality of life.

Key words:

Lung cancer, Cancerous pain, Lappaconitine, Acupuncture, Pain medium

史悦王丹.

穴位注射高乌甲素联合针刺治疗肺癌化疗患者癌性疼痛及对疼痛介质水平的影响 [J]. 国际医药卫生导报, 2025, 31(15): 2476-2481.

Shi Yue, Wang Dan.

Acupoint injection of lappaconitine combined with acupuncture in the treatment of cancer-related pain in lung cancer chemotherapy patients and its effect on pain mediator levels [J]. International Medicine and Health Guidance News, 2025, 31(15): 2476-2481.

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