癌症三阶梯止痛563例分析

The Effects of Three Step Analgesic Ladder Therapy in 563 Cases of Cancer Pain

目的:观察癌症疼痛患者用三阶梯止痛治疗的疗效与不良反应。方法:563例经病理诊断的恶性肿瘤患者,按疼痛程度不同给予不同的止痛治疗。Ⅰ级疼痛:消炎痛25mg,白天1次/4h,共4次,睡前加或不加安定口服。Ⅱ级疼痛:用上述药物后观察24h,若疼痛无缓解,改用舒尔芬1片口服,每天4次,睡前加用安定口服。Ⅲ级疼痛:在Ⅱ级疼痛用药的基础上加用吗啡片5mg,1次/4h,据实际疗效来调整用量,每次递加5mg,直至患者无痛;或者加吗啡控释片(美施康定)30mg,1次/12h,逐渐递加,直至达到满意止痛效果。结果:563例患者中,529例有效,总有效率94.0%。Ⅰ级疼痛止痛有效率为100%,Ⅱ级疼痛止痛有效率为97.2%,Ⅲ级疼痛止痛有效率为79.0%。不良反应:皮疹5例,黑便3例,尿潴留7例,诱发肝昏迷1例。用鸦片类镇痛药止痛者105例,无1例出现精神依赖。结论:世界卫生组织推荐的三阶梯止痛法,安全、有效,应大力推广,造福患者。

Objective: To observe the efficacy and side effects of the three steps analgesic ladder for cancer pain management. Methods: 563 cases of malignant tumor patients diagnosed by pathology, include 311 male and 252 female, the median age was 56 years (ranged from 12~77 years), KPS were 20~80. All patients were administered the analgesic according to different degree. Indomethacin 25mg by oral per 4 hours in daytime were used in 1st degree; Shuerfen one tablet by oral per 4 hours in daytime and diazepam by oral before sleeping were used in 2nd degree; Shuerfen one tablet and morphine 5mg by oral per 4 hours in daytime and MS Contin 30mg plus diazepam by oral before sleeping, if necessary , increase morphine 5mg per times until pain relief in 3rd degree. Results: 529 cases had response in all 563 patients, the overall response rate was 94%, the response rate were 100% in 1st, and 97.2% in 2nd degree, and 79% in 3rd degree. Cutaneous eruption occurred in 5 cases, dark stools in 3 cases, uroschesis in 7 cases, hepatic coma in 1 cases and no addiction occurred in all 485 cases who used opium. Conclusion: The three steps analgesic ladder for cancer pain management introduced by WHO is safe and effective.