- 學位論文
中、西藥品輔助嗎啡作用之研究
Evaluation of therapeutic effects of combined use of morphine with Chinese and Western analgesics
摘要
鴉片類止痛藥仍是目前最有效之止痛劑，但其伴隨之副作用與成癮性是極需改善之課題。目前臨床上普遍與非類固醇類消炎藥物（NSAIDs）、三環類抗憂鬱劑（tricyclic antidepressant）、抗焦慮劑（anxiolytics）、抗癲癇劑（anticonvulsants）、口服局部麻醉劑（oral local anesthetics）、類固醇（corticosteroids）、抗痙攣劑（antispasmodics）等藥物合併使用，以期增強止痛效果。根據文獻指出，嗎啡併用以上輔助劑僅有45%以上的病人有止痛之效果，且副作用的產生機率也有上升的趨勢。因此，本論文利用實證醫學之研究方法，利用證據積分、問題支持度、Jadad score評估文獻的可信度及嚴謹度，觀察嗎啡併用西藥止痛輔助劑的止痛效果。結果顯示：抗癲癇劑、類固醇、局部麻醉劑、抗焦慮劑及非類固醇抗發炎藥與嗎啡併用有增加止痛的功能，但結果不如預期，且副作用有增加的趨勢；抗憂鬱劑則不能增加止痛效果之結果，但評讀樣本數過少，難以了解其與嗎啡併用之療效。 另一方面，本論文找出化濕藥的茯苓（利尿）、解表藥的麻黃（解熱）、瀉下藥的大黃（瀉下）、活血化瘀藥延胡索（止痛）、補益藥的芍藥（止痛）五種相似於西藥止痛輔助劑效果的中藥，利用醋酸扭體、輻射熱源法、機械性刺激三種方法，分別與嗎啡併用，觀察是否可以增加止痛之效果。結果顯示，嗎啡與五種中藥單獨使用皆有止痛的作用；中、西藥合併使用後，嗎啡止痛效果也被上述中藥所增強。 綜合上述結果發現，嗎啡除了利用西藥止痛輔助劑降低嗎啡使用量與增強止痛效果外，中藥也能有效的降低嗎啡使用量與增強止痛效果，顯示中藥對於增加止痛效果或減少嗎啡劑量皆有幫助，如能應用於臨床上，將使疼痛病人有更多的用藥選擇。
並列摘要
Opioids are potent anodynes. However, these type of analgesics may generate numerous side effects and abuse that complicate and limit their use. Opioid are frequently combined use with non-steroidal anti-inflammatory drugs (NSAIDs), tricyclic antidepressants (TCA), anxiolytics, anticonvulsants, oral local anesthetics, corticosteroids, or antispasmotics in order to improve analgesic efficacy. Previous study reported that combined use of opioid with these medications have increase analgesics effect in 45% patients. We have systematically reviewed literatures investigating analgesic effects of combined therapy of opioids with western medication. Result from the review revealed that combination therapy of opioid with antispasmotics, steroids, local anesthetics, anxiolytics, NSAIDs, and morphine could increased analgesic effect, but also increased the side effects. Combined therapy of opioid with antidepressants did not augment analgesic efficacy. On the other hand, we investigated the antinociceptive activity of combined therapy of morphin with five herbal analgesics, the diuretic Poria cocos that transforms dampness, the antipyretic Ephedra sinica that releases the exterior pathogen, the purgative Rheum palmatum that drains pathogen downwards, the tonic Paeonia lactiflora and Corydalis yanhusuo that regulate the blood by acetic acid induced writhing response, radiant heat and mechanical nociceptive stimulant induced paw withdrawal response. The results showed that morphine and the five Chinese medicines have analgesic activity, and the analgesic activity of morphine could be enhanced by each one of the five Chinese medicine. According to our results, combination therapy of morphine with Chinese medicines can reduce morphine dosage and enhance analgesic effect, suggesting these kinds of combined therapy may be another useful strategies to optimize pain management.