大剂量阿片类药物治疗终末期癌痛患者的临床分析

CLINICAL ANALYSIS ON HIGH-DOSE OPIOIDS ANALGESICS IN THE TREATMENT OF CANCER PAIN IN TERMINAL PATIENTS

目的:分析大剂量阿片类止痛药物治疗终末期癌性疼痛的疗效及安全性。方法:南京市中医院肿瘤内科2006年3月～2009年5月住院治疗晚期恶性肿瘤患者中,有26例因重度疼痛需要大剂量阿片类(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:26例患者中,17例为消化道肿瘤;15例合并骨转移,9例有腹膜后淋巴结转移;躯体痛16例,神经病理性疼痛15例,内脏痛12例,混合性疼痛18例。治疗过程中13例患者经历阿片类药物转换。使用强阿片类药物时间为58～541d,中位时间为185.5d。滴定至最大剂量的时间为3～312d,中位时间为89d。最大剂量范围为330～1200mg/d,中位最大剂量630mg/d。大剂量阿片类持续时间为21～383d,中位时间为89d。出现疼痛后生存期为2～43个月,中位数为18个月。未出现严重不良反应。结论:大剂量阿片类止痛药对终末期癌痛患者是安全有效的。

Objective：To analyze the efficacy and safety of high-dose opioid analgesics in terminal patients with cancer pain.Methods：To retrospectively analyze the clinical data of 26 patients with terminal cancer pain and received high-dose opioids analgesics （oral morphine equivalent dose ≥ 300 mg/d） from March 2006 to May 2009.To collect the data of clinical diagnosis,opioid analgesics titration,opioid analgesics dosage,and survival time as associated with opioid analgesics,and the side-effect of opioid analgesics.Results：Of the 26 patients,there were 17 with gastroenteric tumor,15 with bone metastasis,9 with retroperitoneal lymphnode metastasis,16 with somatic pain,15 with neuropathic pain,12 with visceralgia,and 18 with mixed pain.Opioid rotation was found in 13 patients.The duration of high-dose opioids analgesics were in range of 58 days to 541 days （median,185.5 days）.The time to maximum dose of opioids analgesics were 3 days to 312 days （median 89 days）.The maximum dose of opioids analgesics were 330～l200 mg /day （median,630 mg /day）.The duration of high-dose opioids analgesics were in range of 21 days to 383 days （median,89 days）.The survival time after cancer pain was 2～43 months （median,18 months）.There were no life-threatening side-effects.Conclusion：The use of high-dose opioids analgesics was proved safe and effective for terminal patients with severe cancer pain.