对晚期重度癌痛伴有爆发性疼痛患者的临床回顾性调查

CLINICAL REVIEW OF PAIN MANAGEMENT FOR ADVANCED CANCER PATIENT WITH SEVERE PAIN ACCOMPANIED BREAKTHROUGH PAIN

目的:研究调查北京肿瘤医院宁养院15例晚期重度癌痛伴爆发性疼痛(简称:爆发痛)患者,回顾观察宁养院在控制慢性癌痛、减少爆发痛处理的合理性,为规范化疼痛治疗和爆发痛处理提供借鉴。方法:选取宁养院2007年9月至2007年12月开始治疗,并于2007年12月至2008年3月期间死亡的病例中的晚期癌痛伴爆发痛,且使用阿片类药物超过6周、病程记录完整的全部患者15例,对患者镇痛药物使用和爆发痛控制方法进行分析。对患者疼痛控制情况、爆发痛次数、爆发痛强度(用VAS评分)以及爆发痛控制药物使用方法进行评价。结果:经过宁养院镇痛治疗后患者VAS疼痛评分显著下降,爆发痛次数显著减少;多数患者(11/15)为复合性痛;疼痛处理中普遍使用了辅助药物及个体化使用了强阿片类药物,并以即释吗啡控制爆发痛。结论:对晚期癌痛伴爆发痛患者按照WHO三阶梯止痛原则实施综合性个体化的止痛方案,可以控制慢性癌痛,有效减少爆发痛次数。

Objective:To review 15 advanced cancer patients with symptoms of severe pain and breakthrough pain, and evaluate the rational management of chronic pain and reduction of breakthrough pain in a hospice center for reference to future pain, especially breakthrough pain management. Methods:The advanced cancer patients with severe pain and breakthrough pain who received service during the period of September 2007 to December 2007 and died between December 2007 to March 2008 at the Hospice Center of Beijing Cancer Hospital and received opioid treatment for more than 6 weeks with complete patient record were recruited. Totally 15 patients met the criteria. The patients were analyzed on pain scale, pain frequency, especially the happening of breakthrough pain, drug use and pain management effect after treatment. Results:After treatment by the Hospice Center, both the patients' VAS scale and frequency of happening breakthrough pain reduced significantly. Most patients(11/15)suffered from mixed pain and had supportive treatment together with strong opioid drug which played an important role in the pain management. Conclusion:Chronic pain can be controlled and the frequency of breakthrough pain can be reduced if we follow WHO three ladder pain management principles and apply individualized and comprehensive treatment to treat advanced cancer patients with severe pain and breakthrough pain.