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目的探讨奥施康定联合氯诺昔康治疗骨转移癌患者中重度疼痛的疗效及安全性。方法将283例患者随机分为两组,实验组(145例)接受奥施康定+氯诺昔康治疗,对照组(138例)接受奥施康定治疗。实验组中氯诺昔康片的用法为8 mg bid,与奥施康定同日开始服用。实验组及对照组中所有患者均使用奥施康定滴定,由10 mg q12 h开始使用,根据疼痛缓解程度进行剂量调整,达到疼痛缓解时(疼痛NRS评分≤3分),维持治疗直到观察终点,观察用药10 d后两组的镇痛疗效及不良反应。结果实验组与对照组在用药10 d内所有患者疼痛明显缓解。实验组使用高剂量奥施康定人数比例为20%,而对照组为31.2%,实验组高剂量人群比例低于对照组,差异有统计学意义(P<0.05)。实验组与对照组便秘发生率分别为14.5%和25.4%,实验组便秘发生率低于对照组,差异有统计学意义(P<0.05)。但实验组与对照组在头昏、呕吐、呼吸困难、排尿困难、转氨酶增高等不良反应方面差异均无统计学意义(P>0.05)。结论氯诺昔康联合奥施康定可以控制骨转移癌的疼痛;联合用药显著减少了高剂量奥施康定使用的人数,氯诺昔康增加了其止痛效果,且减少了便秘的发生;奥施康定联合氯诺昔康治疗可作为临床治疗骨转移癌疼痛的一种较理想的治疗选择。
Objective To investigate the efficacy and safety of oxycodone combined with lornoxicam in the treatment of severe pain in patients with bone metastases. Methods 283 patients were randomly divided into two groups. The experimental group (145 cases) received OxyContin + lornoxicam and the control group (138 cases) received OxyContin treatment. The use of lornoxicam tablets in the experimental group was 8 mg bid and was started on the same day with oxycodone. All patients in the experimental group and control group were given oxcatine titration starting from 10 mg q12 h. The dosage was adjusted according to the degree of pain relief to achieve pain relief (pain NRS score ≤3), maintenance treatment until the end of observation, After 10 days of treatment, analgesic efficacy and adverse reactions in both groups were observed. Results The experimental group and the control group in the medication within 10 days of all patients with pain relief. The proportion of high-dose OxyClin in the experimental group was 20%, while that of the control group was 31.2%. The proportion of high-dose group in the experimental group was lower than that of the control group (P <0.05). The incidence of constipation in experimental group and control group were 14.5% and 25.4%, respectively. The incidence of constipation in experimental group was lower than that in control group (P <0.05). However, there was no significant difference between the experimental group and the control group in adverse reactions such as dizziness, vomiting, dyspnea, dysuria, and aminotransferase (P> 0.05). Conclusions lornoxicam and oxycodone can control the pain of bone metastases; the combination therapy can significantly reduce the number of high-dose oxycodone used, lornoxicam increases its analgesic effect and reduces the incidence of constipation; Kangding combined with lornoxicam therapy can be used as a more ideal treatment for the treatment of bone metastases pain.