成人常用镇痛药治疗儿童癌痛的可行性及疗效

Feasibility to Treat Pediatric Cancer Pain with Analgesics for Adults and Their Efficacy

背景与目的:因人们对儿童癌痛的诊治认识不足以及缺乏儿童剂型的镇痛药,目前国内儿童癌痛的治疗仍不理想。本研究通过总结中山大学肿瘤防治中心对儿童癌痛的诊治经验,探讨以成人常用镇痛药治疗儿童癌痛的安全有效性。方法:对国内上市的几种常用镇痛药(大部分为成人剂型)如吗啡控释片、羟考酮控释片、芬太尼透皮贴剂等,根据其组分及儿童对该组分的耐受量,拟定儿童用量、用法,并按WHO癌痛三阶梯治疗原则治疗139例初治儿童肿瘤患者的癌痛,其中轻度疼痛19例,中度疼痛41例,重度疼痛79例。评价疗效及不良反应。结果:104例(74.8%)患者仅接受1个WHO阶梯的镇痛药治疗,35例(25.2%)患者需改用更高或更低WHO阶梯的镇痛药治疗。治疗后癌痛中度缓解3例(2.2%),明显缓解7例(5.0%),完全缓解129例(92.8%),镇痛总有效率为100%。癌痛治疗中位时间为5天(1～12天)。使用吗啡控释片、芬太尼透皮贴剂和羟考酮控释片的患者分别为20例、28例和40例,中位年龄分别为10岁(5～18岁)、6岁(2岁4个月至16岁)和5岁(2岁6个月至16岁);3种药物的单次用药最大量中位数分别为20mg(10～70mg)、25μg/h(12.5～50μg/h)和10mg(5～30mg),每例患者总用量中位数分别为100mg(20～360mg)、5mg(1.25～7.5mg)和60mg(10～200mg)。非甾体类抗炎药的不良反应仅见恶心、呕吐,且发生率较低。弱阿片类药物及强阿片类药物的不良反应以便秘、恶心、呕吐、嗜睡等为主,经积极的对症、支持治疗或停药后均能缓解。未出现呼吸抑制或成瘾等严重不良反应。结论:WHO癌痛三阶梯治疗原则适用于儿童,目前国内成人使用的镇痛药能用于绝大部分患儿的癌痛治疗。

BACKGROUND ＆ OBJECTIVE： Lacking enough knowledge of pediatric cancer pain and pediatric dosage form of analgesics, current treatment of pediatric cancer pain in China is unsatisfactory. This study was to probe the efficacy and safety of treating pediatric cancer pain with analgesics for adults through summarizing the experience of diagnosis and treatment in Cancer Center of Sun Yet-sen University. METHODS： Basing on the components and the endurable dosage of each component for children, we formulated the appropriate dosage and usage of a few analgesics （including sustained release tablets of morphine, oxycodone and transdermal fantanyl） available in China, most of which were used in adults. Cancer pain of 139 children with newly diagnosed tumors were treated according to the World Health Organization （WHO） analgesic ladder, including 19 cases of mild pain, 41 cases of moderate pain and 79 cases of severe pain, Efficacy and adverse events were evaluated. RESULTS： Of the 139 patients, 104 （74.8%） were treated with analgesics of 1 WHO ladder step, 35 （25.2%） were treated with increased WHO ladder steps （ladder 1→2 or 2→3） or reduced WHO ladder steps （ladder 3→2 or 2→1）. The total response rate for pain relief was 100%. 129 （92.8%） patients had complete relief, 7 （5.0%） had obvious relief, 3（2.2%） had moderate relief. The median time for pain control was 5 days （range, 1-12 days）. Sustained release tablets of morphine, transdermal fantanyl, and sustained release tablets of oxycodone were used in 20, 28, and 40 patients, respectively. The median ages of the 3 groups were 10 （5-18）, 6 （2.3-16）, and 5 （2.5-16） years, respectively. The median of maximum dosages of the 3 single drugs were 20 （10-70） mg, 25 （12.5-50） μg/h, and 10 （5-30） mg, respectively. The median doses used in the 3 groups were 100 （20-360） mg, 5 （1.25-7.5） mg, and 60 （10-200） mg, respectively. The non-steroid anti-inflammatory drug-induced adverse events were nausea and vomiting with very low frequencies. The weak opioid and strong poioid drug-induced adverse events included constipation, nausea, vomiting, and somnolence, all of which were reversible. No severe adverse events, including respiratory depression and drug addiction, happened. CONCLUSIONS： The WHO ladder approach for cancer pain is appropriate for children. Currently in China, most analgesics for adults could be used for pediatric cancer pain treatment.