吗啡皮下注射联合芬太尼透皮贴治疗中重度癌痛患者的并发症及其护理

Complications and Nursing for Patients with Moderate-severe Cancer Pain by Subcutaneous Inyection of Morphine and Fentanyl Transdemal System

目的探讨吗啡皮下注射联合芬太尼透皮贴治疗中重度癌痛患者的并发症及其护理。方法选取2010年5月至2011年5月在浙江省肿瘤医院治疗的30例中重度癌痛且口服缓释吗啡耐药患者,采用盐酸吗啡皮下注射,待患者疼痛稳定后将24h所需的盐酸吗啡总量转换成芬太尼透皮贴剂用量,长期维持使用,观察其并发症并给予对症处理。结果本组29例患者疼痛控制良好,1例患者疼痛控制失败。药物不良反应有便秘、恶心、呕吐、头晕、嗜睡、排便困难等,通过精心护理后缓解。结论吗啡皮下注射后芬太尼透皮贴剂长期使用能有效控制疼痛。治疗过程中应加强对早期不良反应的观察及处理,以避免严重并发症的发生。

Objective To observe the complications in moderate-severe cancer pain patients by subcutaneous-injection of morphine and Fentanyl Transdemal system and to summarize the nursing points.Methods From May 2010 to May 2011,30 patients with moderate-severe cancer pain and tolerance by oral sustained-release morphine in Zhejiang Cancer Hospital used morphine injection 24h.When the pain was stable,the 24h sum of the total injection morphine was converted to the total amount of transdermal fentanyl system,with a long-term maintenance using.The complications were closely observed and treated accordingly.Results After the treatment,29 cases were completed successfully and one case failed.The adverse reactions of titration treatment included constipation,nausea,vomiting,dizziness,drowsiness,difficulty in defecation,which can be relieved by careful nursing.Conclusion By converting titration of morphine into the long-term use of transdermal fentanyl system,moderate-severe cancer pain can be effectively controlled.The early observation and treatement of adverse reactions should be strengthened to prevent severe complications.