芬太尼透皮贴剂与吗啡控释片治疗癌痛的临床观察

Clinical observation of transdermal Fentanyl and Morphine controlled-release tablets used in patient with cancer pain

目的观察芬太尼透皮贴剂(多瑞吉)与吗啡控释片治疗癌痛病人的镇痛效果及副作用。方法 120例癌症疼痛病人随机分为3组,每组40例。组Ⅰ使用芬太尼透皮贴剂25μg/h,每72h一次。组Ⅱ口服硫酸吗啡控释片 (美施康)30mg,每12h一次。组Ⅲ口服盐酸吗啡控释片(美菲康)30mg,每12h一次。3组均为晚期癌症病人,且伴有中到重度疼痛。观察7-30d的镇痛效果及副作用。结果观察3组患者的疼痛缓解程度,达到完全缓解和明显缓解的均在90％以上,详见表1。说明3种方法均有明显的止痛疗效。3组患者的副作用见表2。其中组Ⅰ患者的嗜睡、恶心、呕吐及便秘的发生率低于其他两组。同时,我们观察到对于某些由于多种因素引起的“难治性疼痛”的患者,在使用芬太尼透皮贴剂的同时,配合使用其他吗啡制剂或一些侵入性方法(如神经阻滞和椎管内用药等),能取得较为满意的止痛疗效。结论芬太尼透皮贴剂治疗癌痛具有副作用小、使用方便和作用持久的特点。对于某些“难治性疼痛”的癌痛患者,应配合应用其他的止痛方法。

Purpose Compare analgesia and adverse effect of transdermal Fentanyl and Morphine controlled-release tablet on patients with cancer pain. Methods 120 patients are randomised into 3 groups. Each group with 40 cases. Group 1: transdermal Fentanyl 25ug/h for every 72 hours. Group 2: Morphine sulphate controlled-release tablets 30 mg for every 12 hours. Group 3: Morphine hydrochloric controlled-release tablets 30mg for every 12 hours. Three groups are all late staged cancer patients with moderate to severe pain. Observe analgesia and adverse effects for 7-30 days. Results Observe pain relief effect, more than 90% are completely or obviously relieved.See form 1. Three groups all have obvious analgesia effect. Adverse effect see form 2. Incidence of nausea, vomiting, constipation, dizziness and lithery in Group 1 is lower then Group 2 and 3. To incurable pain, transdermal Fentanyl combined with other Morphine agent or invasive methods such as nerve block and subachronoid aneasthesia, analgesia effect can be more satisfying. Conclusion Transdermal Fentanyl used in patients with cancer pain has less adverse effects than that of Morphine controlled-release tablet, however it is more convenient with longer lasting effect. For some cancer patients with 'incurable pain', it can be used with other methods.