晚期癌症患者麻醉药品用药情况及用药后生活质量主观满意度评价

Administration of anesthetic drugs in patients with terminal cancer and their subjective satisfaction with quality of life after administration

目的:调查汕头大学医学院第一附属医院宁养院麻醉药品使用情况及患者治疗前后行为状况和生活质量主观满意度,为准确有效地对晚期癌症患者使用麻醉药品改善患者生活质量提供参考。方法:汕头大学医学院第一附属医院宁养院1999-01/2003-01中晚期癌症患者503例。患者材料来源于本院宁养院1999/2003年麻醉药品专帐登记本、麻醉药品处方及其他相关资料。对患者止痛所用的麻醉药品的用药品种、数量进行统计分析,计算用药频率(某药品年消耗量/该药品限定日剂量值),并评估患者治疗前后状况,①评价患者行为状况采用行为状态量表记分标准:无改善,治疗前后行为状态量表评分变化<10分;改善Ⅰ级,治疗后行为状态量表评分增加>10分;改善Ⅱ级,治疗后行为状态量表评分增加>20分;改善Ⅲ级,治疗后行为状态量表评分增加>30分;改善Ⅳ级,治疗后行为状态量表评分增加>40分;改善Ⅴ级,治疗后行为状态量表评分增加>50分。②评价患者生活质量主观满意度采用国内1990年制订的肿瘤患者生活质量量表评分标准,包括闲暇活动、住居状况、家庭关系、社会交往、健康、总体生活状况6个方面,每个方面满分1分,总分6分,分数越高表示患者主观满意度越高。结果:503例患者资料进入结果分析。①麻醉药品使用情况:共使用7个品种的麻醉药品,麻醉药品总消耗数量及用药频率呈逐年增长趋势,其中口服吗啡制剂的用药频率最高,5年总计达73963人次,用量总计为4607.2g,占总用药量的92%。②治疗前后患者行为状态的变化:无改善59例,改善Ⅰ级347例,改善Ⅱ级68例,改善Ⅲ级24例,改善Ⅳ级4例,改善Ⅴ级1例,88.2%(444/503)的患者行为状况得到不同程度改善。③治疗前后患者生活质量主观满意度的比较:治疗后患者闲暇活动、住居状况、家庭关系、社会交往、健康、总体生活状况均高于治疗前犤治疗后:(5.02±0.68),(4.75±0.68),(5.11±0.61),(5.20±0.71),(4.72±1.01),(4.84±1.05)分,治疗前:(4.78±0.79),(4.21±1.09),(4.78±0.94),(4.61±0.99),(4.51±.084),(4.24±0.99)分,P<0.05犦。结论:汕头大学医学院第一附属医院宁养院晚期癌症患者的麻醉药品应用已形成了以口服吗啡制剂为主的体系,应用合理,治疗后患者的主观满意度明显高于治疗前,提示这一形式的止痛治疗能使大多数患者得到较满意的服务,可作为失去根治治疗机会患者的主要治疗方式之一。

AIM： To investigate the administration of anesthetic drugs correlated with the behavior and subjective satisfaction with quality of life （QOL） before and after treatment in patients from the Cozy and Quiet Sanatorium in the First Affiliated Hospital of Shantou University Medical College, so as to provide a basis for the correct and effective usage of anesthetic drugs to the patients with terminal cancer and the improvement of their QOL. METHODS： From January 1999 to January 2003, 503 patients with middie-terminal cancer were selected from the Cozy and Quiet Sanatorium in the First Affiliated Hospital of Shantou University Medical College. The data of patients came from the special register books for anesthetic drugs, prescription of anesthetic drugs and other related data. The kinds and quantity of anesthetic drugs used for analgesia in patients were analyzed statistically to calculate the administration frequency of anesthetic （ratio of the consumption of a kind of drug per year to the limited dosage of this kind of drug per day） and evaluate the status of patients before and after treatment. ①The behavior of patients was evaluated according to Behavior Scale： The score changed less than 10 marks before and after treatment was regarded as no improvement; The increased score over 10 marks after treatment as grade Ⅰ improvement; The increased score over 20 marks after treatment as grade Ⅱ improvement; The increased score over 30 marks after treatment as grade Ⅲ improvement; The increased score over 40 marks after treatment as grade Ⅳ improvement; The increased score over 50 marks after treatment as grade Ⅴ improvement. ②The QOL of patients was evaluated according to the Quality of Life Scale for Patients with Tumors in 1990 including 6 items： leisure activities, living condition, family relation, social communication, health and general living status. Each was scored as 1 mark for a total of 6 marks, and the more the score was, the higher was the satisfaction degree of patients. RESULTS： All the 503 patients were analyzed in the result. ①Usage of anesthetic drugs： Seven kinds of anesthetic drugs were used totally in our study, and their total consumption and administration frequency are in an increasing tendency year by year. Oral morphia was administrated most frequently in a total of 73 963 people among 5 years and at a total dosage of 4 607.2 g （92% of the total consumption of morphia）. ②Behavior changes of patients before and after treatment： No improvement was in 59 patients, grade Ⅰ improvement in 347, grade Ⅱ improvement in 68, grade Ⅲ improvement in 24, grade Ⅳ improvement in 4 and grade Ⅴ improvement in 1. Totally 444 patients out of the 503 patients were improved at different grades in the improvement rate of 88.2%. ③In the comparison of patients＇ subjective satisfaction with their QOL before and after treatment： The scores of leisure activities, living condition, family relation, social communication, health and general living status were significantly higher after treatment than before treatment[（5.02±0.68）, （4.75±0.68）, （5.11±0.61）, （5.20±0.71）, （4.72±1.01）, （4.84±1.05） marks after treatment vs （4.78±0.79）, （4.21±1.09）, （4.78±0.94）, （4.61±0.99）, （4.51±084）, （4.24±0.99） marks hefore treatment, P 〈 0.05]. CONCLUSION： The usage of anesthetic drugs is reasonable and forms a tendency of using oral morphia mainly in patients with terminal cancer from Cozy and Quiet Sanatorium in the First Affiliated Hospital of Shantou University Medical College. The patients＇ subjective satisfaction with QOL is remarkably improved after treatment versus before treatment, indicating that such analgetic treatment can satisfy most of patients and can be used as one of therapeutic manners for the patients who have lost the opportunity to cure radically.