芬太尼透皮贴剂治疗多发性骨转移疼痛的近期疗效观察

Response of Transdermal Fentanyl to Bone Pain of Patients with Bone Metastases

目的：观察芬太尼透皮贴剂治疗恶性肿瘤合并骨转移所致骨痛的效果。方法：从1999年10月起，将60例骨转移瘤伴有中度以上疼痛的患者随机分成2．5mg／贴和5．0mg／贴两个治疗组，每组30例，观察其止痛疗效、生活质量的变化及毒副作用。结果：两治疗组止痛显效率分别为70％和74％，平均起效时间分别为3．2和2．8小时，平均止痛持续时间分别为53．4和60．6小时，差异无显著性；骨痛和生活质量Karnofsy评分治疗前后差异有显著性；但两组之间比较，无统计学意义。芬太尼透皮贴剂常见的毒副作用是头晕、恶心呕吐、便秘、嗜睡等症状，并以5．0mg治疗组副作用大。结论：芬太尼贴剂作为长效麻醉止痛药，具有使用方便、疗效确定和毒副作用小的特点。虽然，2．5mg／贴和5．0mg／贴两个治疗组比较，差异无显著性；但从表面看，2．5mg／贴和5．0mg／贴两种剂型药物总有效率、其起效时间和持续时间略有差异，但毒副作用以5．0mg芬太尼为重。

Objective To investigate the response rate of transdermal fentanyl system or Duragesic to relieve bone pain by bone metastases． Methods From October 1999 to April 2000 60 patients suffered from middle or serious bone pain caused by bone metastases were randomly divided into 2．5mg and 5．0mg treatment groups． Each group consisted of 30 patients． Therapeutic response quality of life and toxic effect were studied． Results The response rate of 2．5mg and 5．0mg groups were 70％ and 74％ respectively． The initial time of effect of these two groups were 3．2 and 2．8 hours and it could be sustained for 53．4 and 60．6 hours respectively even without significant difference P＞0．05． But the difference of bone pain score and Karnofsy value before and after treatment was significant P＜0．05． The main toxic effects were nausea vomiting dizziness constipation somnolence etc． Conclusion Transdermal fentanyl system is one kind of effective analgesics for bone pain especially for middle and serious bone pain． Although the therapeutic effect of 2．5mg and 5．0mg dosage has no significant difference but the toxic effect of duragesic must be emphasized．