盐酸羟考酮缓释片联合吗啡片滴定中重度癌痛的临床观察

EFFECTS OF DOSE TITRATION WITH CONTROLLED-RELEASE OXYCODONE AND MORPHINE TABLETS ON THE PATIENTS WITH MODERATE TO SEVERE CANCER PAIN

目的:探讨盐酸羟考酮缓释片联合即释吗啡片滴定癌痛的疗效及不良反应。方法:80例住院中重度癌痛患者应用盐酸羟考酮缓释片联合即释吗啡片滴定,记录患者所需个体化剂量,统计滴定开始后24小时、3天、7天疼痛控制有效率,滴定前、后的疼痛强度变化生活质量变化以及滴定中不良反应。生活质量评价采用EORTC QLQ-C30(v3.0)量表。疼痛强度评分应用数字分级法。结果:80例患者滴定剂量为20 mg/d至200 mg/d。76.3%的患者在滴定后3天内达到稳定剂量。滴定24小时后疼痛控制有效率为70.0%,3天达到76.3%,7天达到91.3%。滴定后7天评价患者总体生命质量、躯体功能、情感功能较滴定前明显改善(P<0.05);滴定中毒副反应主要为便秘(58.8%)、恶心呕吐(40.2%)、口干(17.5%)、头晕(12.5%)、厌食(11.1%)、尿潴留(8.8%)、瘙痒(6.5%)、谵妄5例(6.3%),嗜睡3例(3.8%),经过对症处理均可耐受。结论:盐酸羟考酮缓释片联合即释吗啡片滴定中重度癌痛患者达到良好滴定效果,副反应较轻,明显改善患者生活质量。

Objective：To explore the efficacy, improvement of life quality and adverse events of controlledrelease oxycodone（CR oxycodone） and morphine tablets during the dose titration. Methods： A total of 80 patients（51 men, average age 53.6 years） with moderate to severe cancer pain were titrated with oxycodone hydrochloride controlled- release tablets and morphine tablets. Data were recorded including the dosage, the degree of pain relief, and adverse events on Day 1, 3 and 7 after titration. Pain intensity was assessed using a Numerical Rating Scale（0 - 10）. The life quality was measured with EORTC Core Quality of Life Questionnaire（QLQ-C30） scales during titration. The continuous observation period lasted for 1 week. Results：Final titrated daily doses of 80 patients ranged from 10 mg to 200 mg.76.3% of patients achieved stable analgesic dose within 3 days. Pain remission rate of 24 hours, 3 days and 7 days after medication were 70.0%, 76.3% and 91.3%, respectively. After 7 days＇ medication, the scores of patients＇ overall quality of life, physical function（PF） and emotional function（EF） improved significantly（P 0.05）. Commonly reported adverse events were constipation（ 58.8%）, nausea and vomiting（ 40.2%）, dry mouth（ 17.5%）, dizziness（ 12.5%）, loss of appetite（11.1%）, transient dysuria（8.8%）, itching（ 6.5%）, delirium（6.3%） and somnolence（ 3.8%）. No serious adverse events took place. Conclusion：Dose titration with CR oxycodone and morphine tablets can be accomplished safely and effectively for patients with moderate to severe cancer pain. Individualized principle should be taken during the dose-titration phase because of the complexity of cancer pain.