羟考酮控释片治疗中重度癌性疼痛85例

Clinical efficacy and safety of oxycontin in 85 patients with moderate and severe cancer pain

目的:对羟考酮控释片用于晚期肿瘤合并中重度癌痛患者时的剂量滴定、不良反应、生活质量变化及长期用药的安全性进行临床分析。方法:85例患者应用羟考酮控释片逐步滴定至疼痛评分(NRS)在3以下,记录起始剂量、起效时间、滴定达稳态时间、不良反应及其生活质量情况。结果:82例完成剂量滴定,达到了满意的疼痛缓解。68例患者(82.9%)在60 min内起效,平均起效时间46.3 min。78例(95.1%)患者镇痛持续时间可达12 h。49例(59.8%)患者发生至少1种不良反应。不良反应主要为便秘(49.4%)、恶心呕吐(10.6%)、头晕(5.9%)、排尿困难(4.7%)等,大部分患者经对症治疗可耐受。患者停药后未见成瘾。用药前后患者的生活质量明显改善(P<0.01)。结论:羟考酮控释片可单独使用或与其他非阿片类镇痛药合用作为中重度癌痛患者的初始治疗和维持治疗,也可以作为治疗爆发性疼痛的即时给药。羟考酮控释片对各种性质疼痛疗效无明显差别,长期用药安全,不良反应可耐受,可以明显改善患者生活质量。

Objective： To evaluate the dose titration, adverse event and impact on life quality of oxycontin （controlled-release tablets of oxycodone hydrochloride） in treating the late stage cancer pain. Methods： Oxycontin was administered and titrated in 85 patients whose numerical rating scale≥4. The dose titration and length of time needed to attain stable pain control were evaluated. Adverse event and quality of life （QOL） were assessed. Results ： Of the patients, 82 patients finished at least one cycle of titration and had effective pain control. The analgesic effect of 68 patients （82.9%） began within 60 rain and mean time was 46.3 min. The titration time of 73 patients（89.00/0 ）was within 3 days and mean time was 2.0 days. The analgesic effect maintained up to 12 h in 78 patients （95.1%）. The minimal daily dose of oxycontin was 5 mg and the maximal was 800 mg. At least one adverse event occurred in 49 patients （59.8%）. The main adverse events included constipation （49.4%）, vomiting or nausea （10.6%）, dysuria （4.7%） and dizziness （5.9%）, which could be tolerated by most of patients after symptomatic treatment. The incidence of adverse events was more frequent in female. No drug addiction was observed. The QOL of patients was significantly improved （ P 〈 0.01 ）. Conclusion ： Oxycontin is effective and safe in the treatment of cancer patients with moderate and severe pain. The adverse events can be tolerated, and the QOL of patients can be significantly improved.