儿童癌性疼痛11例药物镇痛疗效观察

Curative Effect of Analgesia in 11 Children with Cancer Pain

目的探讨儿童癌性疼痛的镇痛疗效。方法调查分析2009年6月～2010年1月我院肿瘤门诊诊治的癌性疼痛患儿的临床资料。结果本组11例,男6例,女5例;年龄0～12岁,平均5.7岁;骨和软组织肉瘤5例(45.5%),淋巴瘤及肾母细胞瘤各2例(各占18.2%),肝母细胞瘤及视网膜母细胞瘤各1例(各占9.1%)。躯体痛及内脏痛各5例,混合痛(躯体痛合并神经痛)1例;重度疼痛7例(63.6%),中度疼痛4例(36.4%),其中6例(54.5%)就诊前曾接受过镇痛治疗。所有患儿均按WHO儿童癌性疼痛治疗指南给予治疗,其中予盐酸羟考酮6例,盐酸吗啡片3例,氨酚羟考酮片2例;2例骨和软组织肉瘤、1例视网膜母细胞瘤联合地塞米松治疗,1例骨和软组织肉瘤联合布洛芬镇痛。通过以上治疗后,患者疼痛轻度缓解1例,中度缓解5例,明显缓解4例,完全缓解1例。中度以上疼痛缓解率为91.0%。治疗过程中出现便秘4例(36.4%),恶心、呕吐2例(18.2%),皮肤瘙痒及头晕各1例(各占9.1%)。结论对疼痛进行全面评估并联合应用恰当镇痛药物可使儿童癌性疼痛有效缓解。

Objective To study analgesia in children with cancer pain. Methods Clinical data of children ad- mitted during June 2009 to January 2010 with cancer pain were analysed. Results 11 pediatric patients aged from 0-12 （ Mean = 5.70 yrs） with cancer pain were treated（6/M and 5/F） , including 5 cases （45.5%） of bone and soft tissue sarcomas,2 cases （ 18.2% ） of lymphoma and nephroblastoma respectively, 1 case（9. 1% ） of hepatoblastoma and retinoblastoma respectively, 5 cases of somatalgia and visceral pain respectively and 1 case of mixed pain （ somatalgia and nerve pains）. Pain severity： 4 （36.4%） was moderate and 7 （63.6%） was severe. 6 （54.5%） the patients had taken analgesic therapy before being admitted into our hospital. All the children were treated under WHO＇s pediatric cancer pain guideline： 2 cases were given Oxycodone and Acetaminophen tablets, 3 cases were treated by instant released Morphine and another 6 children took controlled Oxycodone tablets. 2 patients with bone and soft tissue sarcomas and one with mixed pain took Dexmathathone as co-analgesics. 1 patient had Buluofen as a combination. Pain intensity decreased in all patients after treatment： one mild relief case, 5 medium relief cases, 4 obvious relief cases and one complete relief case with a rate of 91.0%. The common side effects were constipation （4 cases： 36.4% ） ; nausea and vomiting （2 cases： 18.2% ）and one itchy skin and one dizziness case （9.1%）. Conclusion An extensive evaluation of pain should be made and a suitable combination of different analgesics can effectively reduce cancer pain in pediatric patients.