芬太尼透皮贴滴定治疗37例晚期癌症疼痛患者临床研究

Clinical Trial of Dosage Titration with Durogesic Control of 37 Patients with Cancer Pain

目的:本研究比较单用芬太尼透皮贴进行剂量滴定和先用美施康定进行剂量滴定后用芬太尼透皮贴自身对照进行晚期癌症疼痛治疗的方法比较。37例患者随机进入单用芬太尼透皮贴组23例(A组),及先用美施康定滴定剂量,后用芬太尼透皮贴组14例(B组)。所有患者为晚期癌症伴有重度疼痛。评价方法采用划线法,如达到75%以上的疼痛减轻为剂量滴定的终点。所有患者观察至少15天以上。结果:A组患者的最终滴定平均剂量为芬太尼透皮贴50μg/h(1.2mg/d),A组患者中需要剂量调整者为8例(35%)。B组患者先用美施康定最终滴定平均剂量为159mg/d,最终滴定平均剂量为62μg/h(1.45mg/d),相当于缓释吗啡和芬太尼透皮贴量比为109:1。A组和B组芬太尼透皮贴最终滴定剂量相比有显著性差异(P<0.05)。两组患者剂量调整的频数相同。A组和B组间控制疼痛的有效率无统计学差异。B组中美施康定的不良反应明显高于芬太尼透皮贴组。结论:作者认为直接使用芬太尼透皮贴进行剂量滴定治疗晚期癌症疼痛,优于采用缓释吗啡进行剂量滴定后换算成芬太尼透皮贴的使用方法。

Objective:To compare the effect of single Durogesic dosage titration and us-ing MS-contin dosage titration first followed by Durogesic self-control in management of advanced cancer pain.Methods:Thirty-seven cancer patients with severe cancer pain were divided ran-domly into group A(with Durogesic to control pain)and group B(using MS-contin first then fol-lowed by Durogesic self-control).The result was evaluated by visual scale and all the patients were followed up at least for more than15days.Results:The final mean titration dosage of group A was50μg /h(1.2mg /day),and8patients of them needed dosage adjustion.In the group B patients,the final dosage titration of MS-contin was159mg /day and the final dosage of Duro-gesic was62μg /h(1.45mg /day).It indicated that the ratio of MS-contin vs Durogesic was109:1with significant statistical difference(P<0.05).These two groups had a same freqnency of dosage adjustment.There was no statistic difference observed in the effective rate of controlling cancer pain between these two groups..The toxicity and side effects of MS-contin in group B was high-er than that of the Durogesic group.Conclusion:The results showed that Durogesic is superior to MS-contin in the treatment of advanced cancer pain.