口服吗啡滴定和静脉吗啡滴定治疗癌性疼痛的疗效比较

<TITLE>AN VALUATION ON THE EFFECTS OF MORPHINE DOSAGE TITRATION VIA ORAL AND INTRAVENOUS ROUTES FOR THE TREATMENT OF CANCER PAIN

目的:探讨阿片类药物治疗癌性疼痛,口服吗啡滴定和静脉吗啡滴定这两种方法的完成时间,不良反应,偏移程度及生活质量的改善情况。方法:两组癌性疼痛患者(n1=n2=30)分别进行口服吗啡滴定和静脉吗啡滴定。记录疼痛缓解程度,生活质量,不良反应,完成时间及偏移程度。结果:两种方法均能很好地缓解疼痛,口服和静脉滴定的缓解率[完全缓解(complete remission,CR)+部分缓解(partial remission,PR)]分别达到96.7%和93.3%。口服吗啡滴定在躯体功能(physicalfunction,PF)、角色功能(role function,RF)、情感功能(emotional function,EF)和认知功能(cognitivefunction,CF)提高率分别为6.8%、13.6%、8.5%和5.3%;静脉吗啡滴定组评分提高率分别为8.5%、13.0%、11.5%和7.7%;口服滴定时不良反应的发生率高于静脉滴定组(p<0.05)。口服吗啡滴定完成时间3.7±2.9天,静脉吗啡滴定完成时间2.9±2.3天(p<0.01),平均偏移程度分别是12%和19.2%。结论:口服滴定反应的吗啡消耗量准确,不良反应稍多,完成时间长,提高生活质量稍逊;而静脉滴定则相反。两种滴定方法各有优缺点,可根据患者实际情况选择使用。

Objective： To evaluate effects of morphine dosage titration via oral and vein for the treatment of cancer-induced pain. Methods： 60 patients with cancer pain were divided into two groups： dosage titration of oral morphine （n1 = 30）, dosage titration of intravenous morphine （n2 = 30）. The degree of pain relief, global quality of life, adverse reactions, completion time and degree of deviation were recorded and studied. Results： Two methods relieved pain well. Pain remission rate of oral morphine dosage titration was 96.7% while intravenous morphine dosage titration was 93.3%. The remission rate of titration of oral morphine in physical function （PF）, role function （RF）, emotional function （EF） and cognitive function （CF） increased 6.8%, 13.6%, 8.5% and 5.3%. The remission rate of titration of intravenous morphine increased 8.5%, 13.0%, 11.5% and 7.7% respectively. The higher incidence of adverse effects in the oral titration was observed. Completion time and degree of deviation of oral morphine titration was 3.7± 2.9 d and 12%, while intravenous morphine titration was 2.9 ± 2.3 d and 19.2%. Conclusion： Contrast to the intravenous titration, oral morphine titration accurately reflects the degree of pain, has more adverse reactions and takes longer time to complete. Both methods have advantages and disadvantages. A favorable treatment method should be choosed according to the actual situation.