世界卫生组织三步止痛阶梯治疗后III-IV期鼻咽癌患者血浆β -内啡肽水平的变化

Diar Mia Ardani, Bakti Surarso, N. Purnami, R. F. Perdana
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摘要

鼻咽癌是耳鼻喉科最常见的恶性肿瘤,慢性疼痛与鼻咽癌相同。根据世界卫生组织(WHO)的建议,疼痛治疗是WHO三级镇痛阶梯。疼痛是主观的,与内啡肽的功能有关。目的分析III-IV期鼻咽癌患者应用WHO三级镇痛阶梯前后疼痛程度与血浆内啡肽水平的关系。材料与方法本研究设计采用前测和后测,无对照设计。给予WHO三步阶梯镇痛治疗,疗程3天。然后,参与者使用视觉模拟量表(VAS)和静脉血中血浆β -内啡肽水平来评定疼痛等级。统计学检验采用相关t检验、Wilcoxon检验和Spearman检验,p < 0.05,置信区间为95%。结果有14例iii期鼻咽癌患者有中度疼痛(78.57%),31例iv期鼻咽癌患者有中度疼痛(83.87%);p = 0.071)。中度疼痛组治疗前后VAS评分分别为82.22和66.67% (p < 0.001)。治疗前后血浆β -内啡肽水平分别为74.89±69.12、72.49±75.53 pg/mL (p = 0.647)。血浆β -内啡肽水平分别为- 19.20±37.72 pg/mL(轻度疼痛)、- 4.76±35.30 pg/mL(中度疼痛)和- 21.67±6.27 pg/mL(重度疼痛);p = 0.717)。结论晚期鼻咽癌患者治疗后疼痛程度有所降低,但血浆β -内啡肽水平无显著差异。
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Changes in Plasma Beta-Endorphin Levels in Stage III–IV Nasopharyngeal Carcinoma Patients Post World Health Organization 3-Step Analgesic Ladder Therapy
Introduction Nasopharyngeal carcinoma (NPC) is the most common malignancy in the field of otorhinolaryngology, and chronic pain is identical with this malignancy. Pain therapy according to World Health Organization (WHO) recommendations is WHO 3-step analgesic ladder. Pain is subjective and related to the function of beta-endorphin hormone. Objective Analyzing the relationship between the degree of pain and plasma endorphin levels in stage III–IV NPC patients before and after the administration of WHO 3-step analgesic ladder. Materials and Methods The study design used pretest and posttest without control design. Participants were given WHO 3-step analgesic ladder therapy for 3 days. The participants then rated the pain scale using the visual analog scale (VAS) and plasma beta-endorphin levels in venous blood. The statistical test used the dependent t-test, Wilcoxon test, and Spearman test with p < 0.05, confidence interval: 95%. Results There were 14 stage-III NPC patients with moderate pain (78.57%) and 31 stage-IV NPC participants had moderate pain (83.87%; p = 0.071). The VAS value in the moderate pain group before and after therapy was 82.22 and 66.67%, respectively (p < 0.001). The values of plasma beta-endorphin levels before and after therapy were 74.89 ± 69.12 and 72.49 ± 75.53 pg/mL, respectively (p = 0.647). Plasma beta-endorphin levels were −19.20 ± 37.72 pg/mL (mild pain), −4.76 ± 35.30 pg/mL (moderate pain), and −21.67 ± 6.27 pg/mL (severe pain; p = 0.717). Conclusion Pain levels in advanced NPC patients have decreased after the therapy, but plasma beta-endorphin levels have no significant difference.
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