24小时错峰使用芬太尼透皮贴剂在带状疱疹性疼痛治疗中的疗效观察

Effectiveness of Peak Load Shifting Use of Transdermal Fentanyl for Pain Control of Herpes Zoster Neuralgia

目的:比较24小时错峰使用芬太尼透皮贴剂(多瑞吉)和常规使用多瑞吉对中、重度带状疱疹性疼痛的镇痛效果及不良反应。方法:36例中、重度带状疱疹性疼痛患者经静脉吗啡滴定后,随机分为两组(n=18),A组使用等效剂量多瑞吉,B组先使用等效剂量一半的多瑞吉,24小时后使用另一半,每贴多瑞吉更换周期均为72 h,以视觉模拟评分(VAS)评定治疗效果。结果:分别于治疗前、使用多瑞吉后3d、7d、14d记录两组患者VAS评分,结果发现两组患者在多瑞吉治疗后3d、7d、14dVAS评分均逐渐降低。但在使用多瑞吉后3d,B组VAS评分明显低于A组(P<0.01),用多瑞吉后7d、14d,两组VAS评分无明显差异(P>0.05)。B组患者在使用多瑞吉7d内恶心、呕吐及头晕不良反应发生率较A组低。结论:多瑞吉24小时错峰使用简单有效,可平稳有效缓解带状疱疹性疼痛,与常规使用多瑞吉相比其不良反应较少。

Objective： To investigate the analgesic effect and adverse reactions of the treatment using transdermal fentanyl（Duragesic） for 24 hours staggered shifts and routine use in patients with herpes zoster neuralgia.Methods： After i.v.morphine titration,thirty-six patients were randomly divided into two groups（n=18）.Patients in Group A used equivalent dose（ED） of Durogesic in the common practice,while patients in Group B used half ED of Group A firstly,and the rest half ED 24 h later.The replacement cycle of ED was 72 hours,and the treatment of ED was estimated via VAS.Results： Record the VAS score of the 2 groups before treatment and that of the 2 groups on the 3rd,7th and 14th day after using Duragesic.The VAS score of the 2 groups was tapered off on the 3rd,7th,14th day after using Duragesic,and the VAS score of the Group B is lower than that of the Group A on the 3rd day after using Duragesic（P0.01）,and there were no significant differences between the 2 groups on the 7th,14th day after using Duragesic（P0.05）,and the adverse events of nausea,vomiting,and dizziness in Group B are lower than those in Group A.Conclusion： Staggered shifts use of Duragesic could provide excellent and steady pain relief for the patients with herpes zoster neuralgia with relatively lower side effects.Complications could also be reduced along with Duragesic treatment.