大剂量阿片类药物治疗癌性疼痛回顾性分析

A retrospective analysis of high-dose opioids analgesics management for cancer pain

目的:观察大剂量阿片类止痛药物控制国人癌性疼痛的疗效及安全性。方法:八一医院肿瘤内科2005年1月～2009年2月住院治疗晚期恶性肿瘤患者中,有21例因重度疼痛而需要大剂量阿片类(口服吗啡等效剂量为≥300mg/d)治疗,回顾性分析其临床诊断,阿片类滴定时间、剂量、使用持续时间以及毒副反应。结果:21例中,16例为胃肠道肿瘤;14例存在骨骼转移,8例有腹膜后淋巴结转移;躯体痛14例,神经性疼痛和内脏痛各9例。治疗过程中17例患者经历阿片类转换。滴定至最大剂量的时间为4～378d(中位时间92d)。最大剂量范围为330d～1 200mg/d(中位数450mg/d)。大剂量阿片类持续时间为12～255d(中位时间61d)。出现疼痛后生存期为2～45个月(中位数11个月)。未出现威胁生命的毒副反应。结论:大剂量阿片类止痛药对具有重度疼痛的国人晚期肿瘤患者是安全有效的。

Objective：To observe the effective and safe of high-dose opioid analgesics in Chinese patients with cancer pain. Methods .To retrospectively analyze the clinical data of 21 patients who received high-dose opioids analgesics （oral morphine equiva- lent dose≥300mg/d） for severe cancer pain relief from January 2005 to February 2009. To collected data regarding medical diagnosis, opioid analgesics titration, opioid analgesics dosage, and survival time as associated with opioid analgesics, and the side-effect of opi- oid analgesics. Results：Of 21 patients,there were 16 with gastroenteric tumor, 14 with bone metastasis, 8 with retroperitoneal lymph node metastasis, 14 with somatic pain, 9 with neuropathic pain, and 9 with visceralgia. Seventeen patients needed opioid rotation for pain relief or adverse effects decrease. The time to maximum dose of opioids analgesics were 4 days to 378 days（ Median 92 days）. The duration of high-dose opioids analgesics were in range of 12 days to 255 days（ median, 61days）. The maximum dose of opioids analge- sics were 330-1 200rag/day （median, 450mg/day）. The survival time after cancer pain were 1-45 months （median, 11 months）. There weren＇t life-threatening side-effects. Conclusion：The use of high-dose opioids analgesics proved safe and effectiveness for Chi- nese patients with severe cancer pain.