基于药学随访的门诊中重度癌痛患者的生存分析

Survival analysis of outpatients with moderate and severe cancer pain based on pharmaceutical follow-up

目的回顾性分析我院门诊中重度癌痛患者的药学随访情况,探讨影响门诊中重度癌痛患者生存期的相关因素,为门诊中重度癌痛患者提供优质的药学服务。方法收集我院分院在2019年1月—2021年9月有药学随访记录的门诊中重度癌痛患者的临床资料。采用Kaplan-Meier法进行生存率及生存时间统计,绘制生存曲线,并行Log-rank检验,采用多因素Cox比例风险模型分析中重度癌痛患者预后的影响因素。结果共纳入135例中重度癌痛患者,男88例,女47例,年龄29~91(64.96±11.01)岁。研究过程中15例失访,随访率为88.9%。患者的整体平均生存时间为(24.59±1.83)个月,中位生存时间为18.00[95%CI(13.50,22.50)]个月,1年生存率为91.8%。单因素和多因素分析结果显示,行放化疗、联用非甾体抗炎药是影响门诊中重度癌痛患者预后的独立保护因素(P<0.05)。患者在随访期间服用盐酸羟考酮缓释片后发生不良反应198例次,以便秘(35.35%)、呕吐(23.23%)和恶心(20.71%)为主;3例患者(昏迷1例,呼吸急促2例)发生严重不良反应导致入院。结论行放化疗、联用非甾体抗炎药是影响门诊中重度癌痛患者生存期的有利因素。门诊药师在药学随访中持续关注中重度癌痛患者放化疗及联合用药情况,为其提供优质的药学服务。

Objective Based on the retrospective analysis of follow-up information of outpatients with moderate and severe cancer pain in our hospital,the paper evaluates comprehensively the related factors affecting their survival,in order to provide professional pharmaceutical care.Methods Clinical data were collected from patients with moderate and severe cancer pain who had pharmaceutical follow-up records from January 2019 to September 2021.The follow-up information was retrospectively analyzed by the Kaplan-Meier method to evaluate the survival rate and survival time,and the survival curve was drawn and the related factors that affected the survival of outpatients with moderate and severe cancer pain were tested by Log-rank test for univariate analysis and Cox proportional hazards regression model.Results A total of 135 outpatients with moderate and severe cancer pain who met the inclusion and exclusion criteria were included in the study,including 88 males and 47 females,aging from 29 to 91,with the mean age of(64.96±11.01).During the study,15 patients were lost and the follow-up rate was 88.9%.The mean overall survival time is(24.59±1.83)months,and the median survival time is 18.00(95%CI 13.5 to 22.5)months.The 1-year survival rate was 91.8%.The results of univariate and multivariate analysis show that chemoradiation and the combined use of NSAIDs and oxycodone hydrochloride sustained release tablets are independent protective factors affecting prognosis(P<0.05).During the follow-up period,198 cases of adverse drug reactions were recorded after patients taking oxycodone hydrochloride sustained-release tablets.Among them,constipation(35.35%),vomiting(23.23%)and nausea(20.71%)were the main types.There were three cases of severe adverse reactions leading to admission,in which one was coma and two were tachypnea.Conclusion Chemoradiation and the combined use of NSAIDs and oxycodone hydrochloride sustained release tablets are favorable factors affecting the survival of outpatients with moderate and severe cancer pain.Pharmacists should pay close attention to chemoradiation and the combined drug use in pharmaceutical follow-up to provide professional pharmaceutical care.