目的 观察奥沙利铂联合卡培他滨(XELOX)化疗联合肠益方治疗老年晚期结直肠癌的临床疗效及其对患者生存质量、免疫功能及血浆硫酸类肝素蛋白多糖2(SDC2)、胞裂蛋白9(SEPT9)水平的影响.方法 回顾性分析2021年1月至2022年6月期间在海南医学院第二附属医院接受治疗的84例老年晚期结直肠癌患者,按治疗方案不同分为两组,每组各42例.观察组在XELOX化疗基础上结合肠益方治疗,对照组仅予以XELOX化疗治疗,均3周为1个周期,治疗4个周期.比较两组患者的临床疗效、生存质量、免疫功能及SDC2、SEPT9阳性率.结果 观察组患者的近期总有效率为78.57％,明显高于对照组(52.38％),差异有统计学意义(P＜0.05).治疗后,观察组患者的CD4+、CD4+/CD8+水平分别为(40.58±2.51)％、1.68±0.37,均明显高于对照组[(30.22±2.39)％、1.25±0.31],差异均有统计学意义(P＜0.05);两组患者治疗后CD8+比较,差异无统计学意义(P＞0.05).观察组患者的生存质量改善率为73.81％,明显高于对照组(42.86％),差异有统计学意义(P＜0.05).观察组患者治疗后的SDC2阳性率、SEPT9阳性率分别为9.52％、16.67％,均明显低于对照组(30.95％、38.10％),差异均有统计学意义(P＜0.05).结论 XELOX化疗联合肠益方治疗老年晚期结直肠癌可取得满意的近期疗效,有助于改善患者的机体免疫功能,并可提高患者的生存质量,且有助于下调SDC2、SEPT9阳性表达.

目的 探讨结直肠癌患者组织和血清外泌体的LASTR水平及临床意义.方法 基于UALCAN在线分析结直肠癌组织的LASTR水平及其与预后的关系.差速超速离心法制备146例结直肠癌患者和127例健康体检者的血清外泌体后采用实时定量PCR(qPCR)检测LASTR水平,分析血清外泌体LASTR水平与结直肠癌临床病理特征的关系,受试者工作特征(ROC)曲线分析外泌体LASTR水平诊断结直肠癌的效能,结合随访数据和多因素分析进行生存分析.结果 478例结肠癌组织的LASTR水平[中位数(25％～75％四分位数范围)]为0.173(0.061～0.351),高于41例正常组织的0.031(0～0.065),166例直肠癌组织的LASTR水平为0.137(0.059～0.267),高于10例正常组织的0.010(0～0.042),差异有统计学意义(P<0.05);结肠癌组织的LASTR水平与总生存期(OS)有关,其中高水平者的OS较短(P<0.05).结直肠癌患者的外泌体LASTR水平为4.538(3.280～5.662),高于健康体检者的1.701(1.298～2.411),差异有统计学意义(P<0.05).ROC曲线分析显示外泌体LASTR水平诊断结直肠癌的曲线下面积为0.929(95％CI:0.900～0.958),当最佳截断值为3.020时约登指数最大,灵敏度和特异度分别为80.14％和92.91％.外泌体LASTR水平与淋巴结转移、分化程度、远处转移、浸润深度、TNM分期和OS有关(P<0.05),而与年龄、性别、肿瘤部位和肿瘤大小无关(P>0.05).外泌体LASTR低水平组的中位OS未达,优于高水平组的47.0个月(HR=5.494,95％CI:3.040～9.928,P<0.001),多因素分析发现外泌体LASTR水平是OS的危险因素(HR=4.165,95％CI:2.974～6.138,P=0.017).结论 结直肠癌组织和外泌体LASTR水平升高且参与了结直肠癌的进展,外泌体LASTR水平对于结直肠癌诊断和预后预测有一定价值.

目的:通过多中心、随机、对照、非劣效性临床研究,证实草乌甲素的疗效.方法:随机数字表法区组随机筛选病例.病人1:1分入对照组和试验组.三家研究中心共筛选入组轻度癌痛32例(对照组16例,试验组16例),中度癌痛63例(对照组29例,试验组34例).对照组口服布洛芬缓释胶囊或曲马多缓释片、试验组口服草乌甲素片.观察时间7天.结果:每日平均疼痛数字评分法(numerical rating scale,NRS)评分,轻度癌痛病人对照组与试验组之间无差异;中度癌痛病人对照组在第4天低于试验组.中度癌痛病人对照组发生14例次不良反应,试验组发生2例次,有显著性差异.中度癌痛病人生活质量评估试验组情绪功能更佳.结论:轻中度癌痛病人在第一阶梯、第二阶梯药物无效或者不耐受情况下,可以考虑选择草乌甲素片镇痛治疗.

目的 探讨晚期恶性实体肿瘤患者临终前血小板的动态变化及其临床意义.方法 回顾性分析2010年1月至2017年12月中国医学科学院肿瘤医院318例晚期恶性肿瘤患者临终前4～8周、2～<4周、1～<2周和<1周的血小板计数水平,并对临床资料及4次检测数据进行统计分析.结果 142例(44.7％)患者在临终前8周内出现血小板减少症.恶性肿瘤患者临终前4～8周、2～<4周、1～<2周和<1周的血小板计数水平呈一定的下降趋势,且临终前不同时期的血小板计数水平差异有显著性(P<0.05).结论 晚期恶性实体肿瘤患者临终前血小板计数水平明显下降,血小板变化情况可以考虑作为预后判断的参考指标.

目的 探讨D-二聚体水平与肿瘤患者导管相关性血栓(Catheter related thrombosis,CRT)发生的相关性.方法 对100例住院的深静脉置管肿瘤患者进行前瞻性研究,动态监测血浆D-二聚体以及静脉多普勒超声检查,观察CRT的发生率、发生时间及血栓类型等.结果 CRT的发生率为12.6％,其中无症状血栓占83.3％.58.3％的血栓发生在置管后2周内,91.7％发生在置管后的置管后4周内.置管后2周血栓组D-二聚体水平显著高于非血栓组(P=0.013).结论 肿瘤患者CRT大部分形成于深静脉置管后4周内,其中无症状性血栓的比例高,动态监测D-二聚体可能有助于其早期诊断.

Aim of the Study: The role of direct-acting oral anticoagulants in the treatment of venous thromboembolism (VTE) in cancer patients compared with the current standard of low-molecular-weight heparin (LMWH) treatment remains unclear. This meta-analysis aimed to evaluate the efficacy and safety of direct factor Xa inhibitors compared with those of LMWH in the treatment of cancer-associated VTE. Materials and Methods: We systematically searched PubMed, EMBASE, Cochrane library, and Web of Science for potential randomized controlled clinical trials and retrospective cohort studies. Data on recurrent VTE (efficacy) and major and minor bleeding events (safety) were extracted, and the odds risks (OR) were analyzed using a random-effect model. Results: A total of nine studies involving 4208 cancer patients with VTE were included in these analyses. Pooled analysis showed that direct factor Xa inhibitors were significantly superior to LMWH in reducing the risk of recurrent VTE (OR = 0.67; 95% confidence interval [CI]: 0.54-0.82). There was no significant difference in the rate of major bleeding between the direct factor Xa inhibitor and LMWH treatments (OR = 1.25; 95% CI: 0.94-1.65). However, the rate of minor bleeding events was higher when a direct factor Xa inhibitor was used instead of LMWH (OR = 1.80; 95% CI: 1.05-3.07). Conclusions: Direct factor Xa inhibitors are superior to LMWH in efficacy in the treatment of VTE in cancer patients, and the safety between the two regimens is comparable except for a slightly higher rate of minor bleeding when the former is used.

目的 比较全胃切除术(TG)与近端胃大部切除术(PG)治疗贲门癌的临床效果.方法 选择2008年1月至2012年3月海南医学院第二附属医院收治的贲门癌患者63例为研究对象,按照手术方式分为TG组(n=33)和PG组(n=30),2组患者术后均给予氟尿嘧啶、亚叶酸钙及奥沙利铂方案化学治疗2个周期,对2组患者治疗效果进行比较.结果 2组患者手术时间、术中失血量及住院时间比较差异均无统计学意义(t=1.426、0.813、0.609,P＞0.05).PG组患者术后切口感染、肺部感染、膈下脓肿、吻合口瘘、反流性食管炎、倾倒综合征、肠梗阻发生率及总并发症发生率分别为3.33％ (1/30)、6.67％ (2/30)、10.00％ (3/30)、13.33％ (4/30)、16.67％ (5/30)、16.67％ (5/30)、10.00％ (3/30)、33.33％(10/30),TG组患者术后切口感染、肺部感染、膈下脓肿、吻合口瘘、反流性食管炎、倾倒综合征、肠梗阻及总并发症发生率分别为6.06％(2/33)、3.03％ (1/33)、3.03％(1/33)、6.06％(2/33)、0.00％(0/33)、21.21％(7/33)、6.06％(2/33)、36.36％(12/33);2组患者术后切口感染、肺部感染、膈下脓肿、吻合口瘘、倾倒综合征、肠梗阻发生率及总并发症发生率比较差异均无统计学意义(x2=0.258、0.458、1.284、0.965、0.211、0.334、0.063,P ＞0.05);TG组患者术后反流性食管炎发生率低于PG组(x2=5.974,P＜0.05).PG组患者术后1、2、3、4、5 a生存率分别为90.00％(27/30)、66.67％(20/30)、43.33％(13/30)、26.67％(8/30)、20.00％(6/30),TG组患者术后1、2、3、4、5 a生存率分别为87.88％(29/33)、72.73％(24/33)、63.64％(21/33)、54.55％(18/33)、51.52％ (17/33);2组患者术后1、2、3 a生存率比较差异无统计学意义(x2 =0.072、0.274、2.607,P＞0.05),TG组患者术后4、5 a生存率高于PG组(x2 =5.039、6.733,P＜0.05).PG组和TG组患者的中位生存时间分别为31.592、44.863个月,TG组患者的中位生存时间长于PG组(x2 =6.992,P＜0.05).结论 TG治疗贲门癌可以降低患者术后并发症发生率,提高远期生存率.

目的 探讨肽基脯氨酰顺反异构酶1(Pin1)和细胞周期蛋白D1(Cyclin D1)在乳腺浸润性导管癌组织中的表达,分析Pin1和Cyclin D1表达与乳腺癌临床特征的相关性.方法 选取2013年1月至2015年1月海南医学院第二附属医院保存的80例乳腺浸润性导管癌组织和40例癌旁正常乳腺组织标本,采用免疫组织化学法检测乳腺浸润性导管癌组织和正常乳腺组织中Pinl和Cyclin D1的表达,并分析Pin1和Cyclin D1表达与乳腺浸润性导管癌病理分级、TNM分期及淋巴结转移的相关性.结果 乳腺浸润性导管癌组织中Pin1和Cyclin D1阳性表达率分别为56.3％(45/80)、45.0％ (36/80),正常乳腺组织中Pin1和Cyclin D1阳性表达率分别为12.5％ (5/40)、20.0％ (8/40);乳腺浸润性导管癌组织中Pin1和Cyclin D1阳性表达率显著高于正常乳腺组织(x2=21.001、7.170,P＜0.05).Pin1表达与乳腺浸润性导管癌病理学分级及淋巴结转移有关(x2=10.381、4.085,P＜0.05),与TNM分期无关(x2=2.544,P＞0.05).Cyclin D1表达与乳腺浸润性导管癌病理学分级有关(x2=7.024,P＜0.05),与TNM分期及淋巴结转移无关(x2=3.236、o.191,P＞0.05).乳腺浸润性导管癌组织中Pin1与CyclinD1表达呈正相关(x2=4.363,P＜0.05).结论 Pin1和Cyc-lin D1在乳腺浸润性导管癌组织中表达上调,其可能与乳腺浸润性导管癌的发生、发展有关.

目的 探讨乳腺手术中预防性使用抗菌药物与术后切口感染的相关性.方法 选择2012年1月-2016年12月医院进行非感染性乳腺手术患者100例,按照患者是否预防性使用抗菌药物分为对照组和观察组,每组50例,其中对照组未使用抗菌药物,观察组使用抗菌药物,对比治疗的效果.结果 两组患者的住院时间,成本-效果比,切口感染情况数据差异均不具有统计学意义,观察组患者的费用消耗高于对照组,数据差异具有统计学意义(P<0.05),两组患者在开始手术前,手术后6小时,手术后24小时,手术后48小时,手术后72小时五个时间点的白细胞计数与体温变化趋势一致.结论 乳腺手术患者预防性使用抗菌药物与手术后切口感染并没有直接关联,非感染性乳腺手术抗菌药物的使用需要符合用药原则,对于降低患者的治疗费用具有一定的意义.

目的:探讨胃肠肿瘤患者应用复方苦参注射液与斑蝥胶囊联合治疗后对其免疫功能、炎性反应的影响.方法:选取2015年6月-2017年6月入住医院进行治疗的88例胃肠肿瘤患者作为研究对象,采用随机数字表法将其分为两组,44例对照组患者采用常规化疗方案治疗,44例观察组患者则采用复方苦参注射液与斑蝥胶囊联合治疗.比较两组患者治疗前后肿瘤标志物水平、免疫功能指标、炎性反应指标变化情况.结果:治疗后,观察组肿瘤标志物CA724、CEA、CA199明显低于对照组(P＜0.05);观察组CD3+(65.82±3.66)％、CD4+ (47.34±4.11)％、CD8+ (21.00 ±2.31)％及CD4+/CD8+ (2.34±0.39)％明显优于对照组CD3 +(60.26±6.21)、CD4+(42.21±3.01)、CD8+ (24.79±2.28)及CD4+/CD8+(1.70 ±0.37)％ (P ＜0.05);观察组CRP(18.01±3.00) mg/L、IL-6(1 438.53±254.58)pg/L、IL-1β (2 267.99±332.68) pg/L、NGC (4.31 ±0.83) 109/L明显低于对照组CRP(22.77±3.11) mg/L、IL-6(1 607.54±260.08)pg/L、IL-1β(3 255.89±357.98) pg/L、NGC(6.31±1.46) 109/L,差异具有统计学意义(P＜0.05).结论:复方苦参注射液与斑蝥胶囊联合治疗胃肠肿瘤的效果明显,不仅抑制肿瘤细胞的转移,减轻患者炎性反应,患者机体免疫功能得到增强,是治疗肿瘤的有效手段.

Objective:To observe and assess effect by morphine injection on relieving cancer pain in malignant tumor patients. Methods:A total of 174 patients with cancer pain at general department ward in Tumor Hospital of Chinese Academy of Medical Sciences,who received morphine injection,from March 22nd 2013 to March 26th 2015 were taken for observation and summary of medical data and curative effect by morphine injection. Results:There were 165 cases with single primary cancer and 9 cases with double primary cancer. Numeric rating scale(NRS)score of patients at admission was(5. 04 ± 2. 04)points,along with breakthrough pain by(1. 10 ± 1. 14)times/ day. There were 55 death cases during hospitalization,and the 119 discharged cases had NRS score as(1. 94 ± 1. 27)points and breakthrough pain by(0. 40 ± 0. 83)times/ day. Differences of NRS score and breakthrough pain times in patients be-tween admission and discharge had statistical significance(P < 0. 05). Before administration of morphine injection,the patients had NRS score as(7. 23 ± 1. 78)points. Their score was(1. 43 ± 0. 82)points after 30 min of morphine in-jection application. Their difference had statistical significance(P < 0. 05). Conclusion:Morphine injection can re-markably relieve cancer pain in patients,and improve quality of life.

Objective: To summarize and analyze the clinical data and treatment of the cancer pain clinical pathway. Methods: There were 357 cases in cancer pain clinical pathway, from March 22, 2013 to March 26, 2015, were involved. Their cancer pain numerical rating scale (NRS), breakthrough pain (BTP) and treatment are summarized and analyzed. Results: On admission there are 135 cases (37.8%) with mild pain, 155 cases (43.4%) with moderate pain, 67 cases (18.8%) with severe pain. 172 cases (48.2%) have BTP, of whom 21 have BTP 3 times/day or more. At discharge 68 patients are dead. In the other 289 patients there are 273 cases (76.5%) with mild pain, 15 cases (4.2%) with moderate pain, 1 case (0.3%) with severe pain. 39 cases (10.9%) have BTP, of whom 4 have BTP 3 times/day or more. Conclusions: The intensity and BTP of the patients'cancer pain are significantly decreased under the management of cancer pain clinical pathway.

Objective To explore the efficacy and safety of laparoscopic assisted radical gastrectomy for distal radical radiotherapy.Methods From January 2009 to December 2011,184 patients in our hospital for radical cancer radical surgery were enrolled,according to the different surgical methods, they were divided into control group and observation group, the control group of 83 cases,observation group of 101 cases,the patients in the control group were treated with traditional open surgery,patients in the observation group were treated with laparoscopic assisted radical gastrectomy for distal gastric cancer, the effect of treatment was compared.Results The operation time of laparoscopic group was longer than that of traditional lapa -rotomy group,and the length of incision and the amount of blood loss were less than those of traditional laparotomy group(t=8.354,t=46.236, t=54.467, P<0.05).There was no significant difference between the two groups in the number of lymph nodes,the distance from the proximal end to the tumor and the distance from the far end to the tumor(t=1.685,t=1.467,t=0.397,P>0.05).The laparoscopic group of patients with postoperative exhaust time,ambulation time,analge-sic use,number of liquid feeding time and hospitalization time were shorter than that of the conventional laparotomy group,the difference was statistically significant(t=16.171,t=12.508,t=15.521,t=9.657,t=12.239,P<0.05).There was no significant difference in the complications and the 5 year survival rate between the two groups(χ2=0.171,χ2=0.572,χ2=1.475,χ2=1.164,χ2=0.826,χ2=0.460, χ2=1.160, P>0.05).The Karnofsky score of the laparoscopic group was higher than that of the traditional laparotomy group on the 5 day after operation,the difference was statistically significant(t=6.906,P<0.05).30 days after surgery,the difference of Karnofsky score between the two groups was not statistically signif-icant(t=0.725,P>0.05).Conclusion The short term effect and long term effect of laparoscopic assisted radical resection of distal gastric cancer D2 is similar to open surgery for radical resection of distal gastric cancer D 2,but the use of laparoscopic operation in patients with less trauma,quick recovery,good safety,it is worthy of promotion in the clinical range.

目的:观察并评价韩氏穴位神经刺激仪(Han's acupoint nerve stimulator,HANS)对阿片耐受癌痛患者的辅助镇痛效果.方法:将阿片耐受的癌痛患者随机分两组,分别予HANS和Mock-HANS(假韩氏)治疗.用患者自评问卷评估基线和第8、15日的疼痛、生活质量和焦虑抑郁,并比较两组治疗后的均值.结果:64例患者完成2周治疗和评估(HANS组33例,Mock-HANS组31例),两组基线资料无显著差异.与Mock-HANS组相比,HANS组第8、15日的“最轻”和“平均”疼痛强度均值、第8日的“最重”疼痛强度均值都显著降低;第8及第15日的“日常生活”及“睡眠”的受干扰程度也明显改善.HANS组第8、15日时的“便秘”、“乏力”、“失眠”以及抑郁的得分均值、第15日的焦虑得分均值都显著低于对照组.结论HANS可有效缓解阿片耐受患者的癌痛,减轻便秘、乏力和失眠等症状,并能显著缓解焦虑抑郁,是一种简便安全的非药物镇痛方法,值得进一步研究和应用.

BACKGROUND:Leptomeningeal carcinomatosis is a rare type of metastatic tumors of the central nervous system. In recent years, with the improvement of neoplasms therapies and longer survival of patients by better systemic control, incidence of leptomeningeal metastases has increased every year. However, there is still lack of effective therapies. The aim of this study is to investigate the efficacy, security and prognosis of intrathecal chemotherapy with methotrexate (MTX) in the treatment of neoplastic meningitis.METHODS:A total of 27 patients were enrolled. We investigated clinical features and cerebrospinal fluid (CSF) examination results retrospectively, and analyzed the adverse reactions as well as prognosis after intrathecal chemotherapy.RESULTS:All 27 patients were treated by intrathecal MTX, 70.4% had clinical remission, however, there was no significant difference in CSF pressure and CSF biochemical changes. We observed that 55.6% patients were all appropriate, 25.9% appeared lower limb numbness and mild pain, no serious irreversible adverse reactions occurred. Median overall survival was 4 months.CONCLUSIONS:We suggest that intrathecal administration of MTX is associated with improvement of symptoms of leptomeningeal metastasis patients and no severe adverse events observed.

[目的]探讨影响中晚期原发性肝癌住院患者死亡的危险因素.[方法]回顾性分析83例中晚期原发性肝癌住院死亡患者的资料,从性别、年龄、乙型肝炎病毒感染、门静脉癌栓、Child-Pugh分级等方面研究影响患者死亡的因素,采用Cox比例风险回归模型进行单因素和多因素分析.[结果]全组患者中位生存时间为12.0月.Cox回归模型分析结果显示:乙型肝炎病毒感染、肿瘤治疗方式、门静脉癌栓、ECOG评分及Child-Pugh分级与中晚期原发性肝癌的预后相关.[结论]乙型肝炎病毒感染、门静脉癌栓、Child-Pugh分级是中晚期原发性肝癌的独立预后因素.

ObjectiveTo analyze the clinical characteristics and death causes of patients with advanced primary liver cancer, and to provide references for reasonable diagnostic and therapeutic strategy.Method Clinical data of 66 inpatients with advanced primary liver cancer (gender, clinical manifestations, death causes) died in our hospital from January 2008 to November 2015 were retrospectively analyzed.Result Patients with chronic HBV infection accounted for 75.8%, and the serum alpha-fetoprotein (AFP) (≥400μg/L) positive rate accounted for 50.0%. The ascites and abdominal pain were common, and most patients suffered from severe pain. The leading cause of death was hepatic failure,and hemorrhagic shock occured in 31.8% of patients.ConclusionImproving early diagnosis rate of primary liver cancer by combined application of various detecting methods, preventing and curing hepatitis and cirrhosis, relieving discomfort of the end-stage patients can prolong survival time and improve life quality of patients.

Objective To evaluate the analgesia effect, drug-related toxicity, and survival of neuraxial epidural analgesia ( EPI) and nonneuraxial comprehensive medical management ( CMM) in patients with abdominal intractable pain caused by cancer of pancreas. Method Randomized controlled study of 48 abdominal intractable pancreas cancer pain patients assigned to each of two groups ( all patients had Visual Analogue Scores VAS for pain≥5/10 on at least 200 mg morphine or equivalent daily):epidural analgesia group ( EPI,24 patients):adopted by epidural implantable drug delivery system, doing side abdominal subcutaneous tunnel, long-term indwelling epidural catheters and external controlled analgesia pump;comprehensive medical management group ( CMM,24 patients) following standard guide-lines in management of cancer pain, adopted by non-invasive treatment, combined analgesia according the WHO's three ladders method, including oral, intravenous, intramuscular, transdermal, PCA and other methods. For this study, measurements are reported for all patients alive at 12 weeks. The measurement point for primary objective was 2 weeks after randomization. Secondary objectives:pain scores over time ( comparison of changes in VAS for pain over the duration of the trial);the NCI-CTC( Common Toxicity Criteria) standardizes the comparison of drug-related ad-verse events over the duration of the follow-up period. Overall survival was represented using curves. Result At 4 weeks,19 of 24 (79. 2%) EPI patients compared with 9 of 23 (39. 1%) CMM patients achieved>20% reduction in both pain VAS and toxicity, 21 of 24 (87. 5%) EPI patients compared with 8 of 23 (34. 8 %) CMM patients a-chieved both>50% reduction in pain VAS and >20% reduction in toxicity, at 4 weeks the EPI patients VAS pain scores decreased from 7. 9 to 3. 2 (59. 5% reduction) compared with 7. 8 to 4. 8 (38. 5% reduction) for CMM patients;the EPI patients NCI CTC scores decreased from 6. 9 to 2. 9(58. 0% reduction) compared with 6. 8 to 5. 8 (14. 7% reduction) for CMM patients . All individual VAS pain scores and drug toxicities improved with EPI at both 4 and 12 weeks than CMM. At 4 weeks,the MOED (Morphine oral equivalent dose,mg/day) was decrease 94. 5% in EPI group and 31. 2% in CMM groups(P<0. 01). At 12 weeks, only 79. 2% of the patients randomized to EPI were a-live, compared with 33. 3% for patients in CMM groups. Conclusion EPI improved clinical success, reduced pain scores, decreased the MOED and relieved most toxicity of pain control drugs, and was associated with increased sur-vival in patients with abdominal intractable pancreas cancer pain for the duration of this 3 month trial.

Objective: To observe the adjuvant analgesic efficacy of Han’s Acupoint Nerve Stimulator(HANS) in opioid tolerant patients with cancer pain. Methods: A prospective non-controlled study was conducted. Opioid tolerant patients with cancer pain were enrolled and treated with both routinely analgesics and adjuvant HANS(2/100 Hz for 30 min/d, 5 d on and 2 d off for two weeks). Cancer pain, quality of life(QOL), anxiety and depression were assessed before enrollment and on d 8 and d 15 with the BPI-C, EORTC QLQ-C30, and self-rating anxiety scale(SAS)/self-rating depression scale(SDS), respectively; the therapeutic frequency of breakthrough pain(BP) and daily opioid dose were also recorded. Results: Totally 47 patients meeting the inclusion criteria participated in this study; 43 patients completed the two-week treatment and assessment. The mean scores of patient’s worst and least pain intensity assessed with BPI-C decreased significantly on d 8 and d 15; the therapeutic frequency of BP also significantly decreased; but the average daily dose of opioids did not change significantly. For the nine symptoms in EORTC QLQ-C30 assessment, the mean scores of pain, fatigue, constipation and insomnia were significantly lower on d 8 and d 15 compared with baseline; the mean scores of the overall health status, nausea/vomiting and the incidence rates of both anxiety and depression also decreased significantly on d 15.Conclusions: To opioid tolerant patients with cancer pain, adjuvant treatment with HANS could improve pain release and patients’ QOL by decreasing the severity of pain, fatigue, constipation, insomnia and other concomitant symptoms; it could also decrease the incidence rates of anxiety and depression.

目的 研究抗抑郁药物作为辅助性干预措施对伴有抑郁状态和癌痛晚期癌症患者的治疗效果.方法 将68例患者随机分为两组,进行为期4周的临床观察.对照组联合使用阿片类药物以及心理干预,治疗组联合使用阿片类药物、心理干预以及抗抑郁药物度洛西汀,采用汉密尔顿抑郁量表(HAMD17)、视觉模拟评分法(VAS)于治疗前及治疗后第1、2、4周末进行疗效评估,观察辅助性抗抑郁药物对伴有抑郁状态的癌痛患者抑郁情绪及联合用药对疼痛改善、阿片类药物使用的情况.结果 在治疗后第1、2、4周末,治疗组患者HAMD17评分显著降低,抑郁情绪明显改善(P＜0.05),对照组患者治疗前后HAMD17评分无明显下降(P＞0.05).治疗组患者在治疗后第2、4周末HAMD17焦虑/躯体化、体重、认知障碍、睡眠障碍以及阻滞各因子分均有显著下降(P＜0.05).治疗组患者阿片类药物使用量在治疗前后无明显增加(P＞0.05),而对照组患者阿片类药物使用量在第4周末有显著增加(P＜0.05).治疗组患者在用药期间未见明显的不良反应.结论 对伴有抑郁状态的晚期癌痛患者,单纯的心理干预和止痛治疗不能明显改善患者抑郁情绪;在接受阿片类药物和心理干预的同时联合抗抑郁药物度洛西汀,其效果优于阿片类药物联合心理干预,能明显缓解患者抑郁情绪,并有益于疼痛的控制.