| Objective:To observe the clinical efficacy of external application of eliminating swelling and analgesic powder combined with Morphine Hydrochloride Sustained-release Tablets in the treatment of moderate and severe cancer pain,providing more effective treatment methods for middle and advanced cancer pain,and giving full play to the characteristic advantages of traditional Chinese medicine in the palliative treatment of tumor.To explore the effect of reducing the pain intensity,improving the rate of pain relief,reducing the number of bursts of pain,reducing the amount of morphine,as well as its clinical application and the theoretical value.Methods:80 hospitalized patients in the oncology department of the Affiliated Hospital of Southwest Medical University from January 2015 to December 2017 were divided into a randomized controlled,single blind,single center prospective study and divided into the treatment group(1 cases in the treatment process,39 cases in total)and the control group(1 cases in the treatment process,39 cases).Two groups of patients were given routine treatment,and the control group was given a titrated dose of Morphine Hydrochloride Sustained-release Tablets to relieve pain.On the basis of the treatment group,the treatment group was used to eliminate swelling and analgesic powder at the same time.Immediately after the onset of pain,morphine was used to relieve pain.The 14 day was 1 courses.After the 1 course of treatment,the pain intensity,the rate of pain relief,the amount of morphine,the control of the explosive pain,the KPS score,the safety assessment and the adverse reaction were statistically analyzed.The results of the study:1.There was no significant difference in gender,age,disease,pain site,pain intensity and KPS score between the treatment groups and the control group(P>0.05),indicating the comparability between the two groups.2.Pain intensity:The pain intensity score(NRS)was used to evaluate the pain intensity before treatment①the NRS score of the treatment group and the control group was(6.41 ±1.45)and(6.87±0.77).②After 4 days of treatment in the two groups,the pain score of the treatment group was(2.85 ± 1.23)and the control group was(2.77 ± 1.16),and NRS between the two groups was carried out.The difference was not statistically significant(p=0.776).③ The pain intensity score of the two groups was NRS(1.54 ±0.72),and the control group was NRS(2.03 ± 0.99),with statistical significance(p=0.015).④The NRS score in the treatment group was more obvious than that of the control group at eleventh days after the treatment.The treatment group NRS(1.31 ±0.52),the control group NRS(1.62±0.67),statistically significant(p=0.027);⑤Two groups of patients after fourteenth days after treatment,NRS score treatment group(0.82±0.68),the control group(1.18 ± 0.72),pain intensity score,the difference between the two groups was statistically significant(p=0.027).3.The rate of pain relief(CR+PR):the pain relief rate of two groups was compared,the treatment group was 94.80%,the control group was 89.70%.The effect of eliminating swelling and analgesic powder combined with morphine to relieve cancer pain was better than that of the control group.The difference was not statistically significant(P=0.098)by using the rank sum test of Z=-1.652.4.The rate of moderate and severe cancer pain relief in the treatment group:①19 patients were moderate pain and 20 patients were severe pain.After 1 courses of treatment,the rate of moderate and severe pain relief was 94.7%and 85%respectively.The rate of moderate and severe pain relief was not statistically significant(P=1.000)in the middle and severe pain(P=1.000).②The curative effect of degree pain was compared.The effect of moderate pain was widely distributed on CR and PR.The effect of severe pain group was widely distributed in PR and MR,and Z=-2.219 was analyzed by rank sum test.The difference of the trend was statistically significant(P=0.026).5.Dosage of morphine:①The dosage of Morphine Hydrochloride Sustained-release Tablets in the two groups for fourth days was observed.The dosage of morphine was(140 ±53.90)mg in the treatment group and the dosage of morphine was(118.46 ± 48.64)mg in the control group.The independent sample t test was used,t=1.853 was not significantly different(p=0.068).②The two group suffered from 24h morphine in the treatment group seventh days after treatment.The dose was(135.38 ± 52.81)mg,the control group was(120 ± 55.06)mg,using independent sample t test,t=1.259,without significant statistical difference(p=0.212).③The dosage of Morphine Hydrochloride Sustained-release Tablets was observed in two groups for eleventh days 24h,the dosage of 24h morphine in the treatment group was(121.54 ± 54.17)mg,and the control group was(129.23 ± 57.65)mg.The dosage of 24h morphine in the treatment group was less than that in the control group.Using independent sample t test,t=-0.607 showed no statistical difference(p=0.545).④ The dosage of Morphine Hydrochloride Sustained-release Tablets in the two groups was observed for fourteenth days in 24h,and the amount of 24h morphine used in the treatment group was(104.62 ± 56.28)mg,the control group was(138.46 ± 55.32)mg,with independent sample t test and t=-2.678,with statistical difference(p=0.009).⑤The dosage of 24h morphine was compared to two groups of patients at fourth and fourteenth days after treatment.Compared with the difference of the change of morphine dosage in 24h,the amount of morphine in the treatment group was decreased and the variance analysis of repeated measurements was used.The treatment group was F=13.441,the decline trend was statistically significant(P<0.001);the dosage of morphine in the control group was also decreased,the variance analysis of repeated measurements and the control group of F=9.590.The dosage of morphine was 20(51.3%)and 2(5.1%)in the treatment group and the control group respectively.The morphine reduction in the two groups was compared with the rank sum test(Z=-4.891),the difference was statistically significant(P<0.001).6.Control of explosive pain:After the end of morphine titration,the number of onset pain occurred in the treatment group for fourth days to fourteenth days(1.62 ±0,71),and the number of onset pain in the control group was(3.08 ± 0.77).The number of onset pain in the treatment group was less than that of the control group,and there was a statistical difference(P<0.01).7.In terms of quality of life,:There was no significant difference in KPS score between the two groups before and after treatment(P>0.05).8.Safety and side effects:①blood routine test,liver and kidney function and electrocardiogram in two groups were not observed after 14 days of clinical observation.② No serious adverse reactions occurred,and external application of swelling and pain relieving powder did not cause allergic reactions.Conclusion:(1)For patients with moderate and severe cancer pain,external use of elimination of Xiao Zhong Zhi Tong powder combined with Morphine Hydrochloride Sustained-release Tablets is superior to the oral treatment of Morphine Hydrochloride Sustained-release Tablets single drug in improving pain intensity,improving the rate of moderate pain relief,reducing the amount of morphine and reducing the number of bursts of pain.It embodies the advantages of TCM External cancer pain.(2)The treatment of moderate and severe cancer pain by using the external use of eliminating swelling and analgesic powder and Morphine Hydrochloride Sustained-release Tablets has ideal clinical effect and no obvious side effects.It is worthy of clinical promotion. |
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