癌痛患者芬太尼静脉自控镇痛滴定芬太尼透皮贴剂的临床观察

Dosage titration of transdermal fentanyl by fentanyl patient-controlled intravenous analgesia in the treatment of cancer pain

目的探讨癌痛患者芬太尼静脉自控镇痛(PCIA)滴定芬太尼透皮贴剂(多瑞吉)的安全性和有效性。方法收集2011年12月至2013年8月我院收治的中重度癌痛患者26例,采用芬太尼PCIA滴定多瑞吉治疗癌性疼痛,分为4个治疗时段(PCIA前、PCIA时、PCIA+多瑞吉和多瑞吉)记录滴定情况、疼痛评分、疼痛对生活的影响评分和不良反应。结果 26例患者中21例滴定成功,5例滴定失败。患者在芬太尼PCIA时、PCIA+多瑞吉和多瑞吉治疗后与PCIA治疗前比较,一般疼痛评分、最严重疼痛评分、活动时疼痛评分、静息时疼痛评分和疼痛对生活的影响评分均有显著下降(P<0.05)。滴定主要不良反应为PCIA治疗中出现的恶心、呕吐,未观察到肌强直、意识丧失、呛咳、瘙痒、呼吸抑制和心动过缓发生。结论癌痛患者PCIA滴定多瑞吉安全、有效、简单易行,并能迅速缓解爆发痛,值得临床推广。

Objective To evaluate the safety and efficacy of transdermal fentanyl（duragesic） dosage titrated by fentanyl patient-controlled intravenous analgesia（PCIA） in patients with cancer pain.Methods From December 2011 to August 2013,26 patients with moderate to severe cancer pain were studied.Titration conditions,pain score（NRS）,scores of pain impacting on life and adverse reactions were assessed and recorded respectively in the four period of treatment（before fentanyl-PCIA,the period of fentanylPCIA,duragesic with fentanyl-PCIA and the period of duragesic）.Results There were 21 cases of successful titration and 5 cases failed.The general pain score,the most serious pain score,activity pain score,resting pain score and scores of pain impacting on life were significantly reduced in the period of fentanyl-PCIA,the period of duragesic with fentanyl-PCIA and the period of duragesic compared with those before fentanyl-PCIA（P 〈 0.05）.The main adverse reactions occurred in the treatment were nausea and vomiting and no obvious muscle rigidity,loss of consciousness,cough,itching,respiratory depression and bradycardia were observed.Conclusion Titration of transdermal fentanyl with fentanyl administrated by PCIA is not only safe,effective and convenient,but also relieving breakthrough pain quickly,be worthy of clinical promotion.