阿米替林联合阿片类药物治疗中重度癌痛伴抑郁患者疗效分析

目的: 探讨阿米替林联合阿片类药物治疗中重度癌痛伴抑郁患者有效性及安全性。方法: 42例癌痛伴抑郁患者随机分为2组，对照组单用强阿片类药物治疗(21例)，研究组采用强阿片类药物联用阿米替林(21例)。通过数字分级法(NRS)、抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD17)、生活质量调查表(SF-36)评估疼痛、抑郁及生活质量改善程度，同时比较两组阿片类药物用量及不良反应等情况。 结果: 两组患者治疗2、4周后疼痛均明显缓解(P<0.01)，且研究组在2、4周的NRS评分均明显低于对照组(P<0.05)；两组抑郁情况得到明显的缓解(P<0.01)，且研究组在2、4周的抑郁评分均明显低于对照组(P<0.05)；治疗后两组生活质量均得到一定程度改善，研究组在情感职能、精力、精神健康、社会功能、躯体疼痛方面更好于对照组(P<0.05)；4周后研究组患者阿片类药物平均日使用剂量少于对照组(P<0.01)，研究组总不良反应发生率稍多于对照组(P>0.05)，其中头昏嗜睡、尿潴留情况明显多于对照组(P<0.05)。结论: 阿米替林联用阿片类药物能有效控制疼痛、缓解抑郁状态，提高癌痛患者生活质量，值得临床进一步的推广。

Therapeutic effect of amtiriptyline combined with opioids for moderate to severe cancer pain patients with depression

AIM: To investigate the effect and safety of amitriptyline combined with opioid for moderate to severe cancer pain patients with depression. METHODS: Forty-two patients with moderate to severe cancer pain and depression were randomly divided into two groups. The control group was given strong opioids (n=21), the treatment group was given opioids combined with amitriptyline (n=21). The digital classification method (NRS), depression self rating scale (SDS) and Hamilton depression scale (HAMD 17), quality of life questionnaire (SF-36) were used to assess the clinical effect of pain, depression and quality of life. In addition, the opioids dose and adverse drug reactions were recorded. RESULTS: Pain was significantly alleviated in each group (P<0.01) after two or four weeks, and the NRS of the treatment group was better than that of the control group after two or four weeks (P<0.05); depression was relieved in each group (P<0.01), and the depression score of the treatment group was better than that of the control group (P<0.05); after the treatment, the quality of life had improved to a certain extent in both groups, and the emotional function, energy, mental health, social functioning and body pain in the treatment group were better than those of the control group (P<0.05); the average daily dosage of opioids for treatment group was significantly lower than that of the control group after four weeks (P<0.01); the total incidence of adverse of the treatment group was slight higher than that of the control gtoup (P>0.05), but the dizziness, sleepiness and urinary retention were obviously more than those of the control group (P<0.05). CONCLUSION: Amitriptyline combined with opioids can effectively control severe cancer pain, relieve depressive symptoms, and improve the quality of life for cancer pain patients, which is referential for clinical application.