阿片类药物治疗老年中重度癌痛不良反应分析

Analysis of Adverse Effects of Opioids in Moderate to Severe Cancer Pain of Elderly Patients

目的探讨阿片类药物治疗老年中重度癌痛不良反应。方法采用回顾性分析的方法,分析了100例老年肿瘤患者应用阿片类药物治疗中重度疼痛的不良反应。采用面部表情疼痛分级量表和数字评定量表综合评定疼痛强度。初次使用强阿片类药物的患者从小剂量开始药物滴定,未达到满意止痛效果者,根据剂量换算确定起始剂量。每天定时记录患者疼痛强度、部位、性质和毒副反应等。结果 100例患者用药时间中位值50d,阿片类药物剂量中位值60mg。93%(93/100)以上的患者达到中度以上缓解。患者不良反应发生率为61%(61/100)。便秘为最常见的(48%)不良反应,其次为恶心/呕吐(24%),嗜睡(12%)、头晕(5%)、皮肤瘙痒(5%)、排尿困难(4%),呼吸抑制(2%)的不良反应较少见。结论阿片类药物能够有效控制老年癌痛,主要不良反应为便秘和恶心呕吐。

Objective To investigate the adverse effects of opioids for elderly patients with moderate to severe cancer pain.Methods The adverse effects of 100 elderly cancer patients with moderate to severe pain treated by opioids were analyzed retrospectively.Faces pain scale and numeric rating scale were used to assess pain intensity.Patients who used opioids initially started to titrate from small dose,and those who used opioid drugs before and did not acquire satisfactory analgesic effect,started with the dose according to opioids dose conversion.Daily pain intensity,location,nature and adverse reactions were recorded regularly.Results The median medication time was 50d,median opioids dose（converted to morphine dose） was 60mg in these 100 patients.93%（93/100） patients achieved more than moderate ease.The incidence of adverse reactions was 61%（61/100） in these of patients.Constipation（48%） is the most common clinical adverse effect,followed by nausea/vomiting（24%）.Lethargy（12%）,dizziness（5%）,skin itching（5%）,dysuria（4%）,and respiratory depression（2%） was rare adverse reaction.Conclusion The opioids can effectively release the cancer pain of elderly patients,the main adverse effects were constipation and nausea/vomiting.