盐酸美沙酮片治疗中重度癌性疼痛的临床观察

Clinical observation of methadone hydrochloride tablet in the treatment of moderate and severe cancer pain

目的观察盐酸美沙酮片（美沙酮）治疗中重度癌性疼痛的临床效果、不良反应及生活质量改善情况。方法 42例中重度癌性疼痛患者给予美沙酮镇痛治疗,初始剂量5 mg/12 h,根据疼痛情况调整剂量,直至患者无痛或基本无痛,每位患者至少治疗15 d以上。观察患者的疼痛缓解情况、生活质量评分及不良反应。结果 42例患者经过个体化给药后确定最终剂量为5-70 mg,每12小时1次,绝大部分患者疼痛达到明显缓解以上,疼痛的总缓解率为90.5%,其中完全缓解11例（26.2%）,明显缓解27例（64.3%）,对中度疼痛的缓解率为93.8%,重度疼痛的缓解率为88.5%。治疗前中位KPS评分为50分,治疗后中位KPS评分为75分,患者的生活质量明显改善（P〈0.05）。全组KPS评分9例（21.4%）明显改善,13例（31.0%）有改善,20例（47.6%）达到稳定,无评分下降病例;不良反应少且轻微。结论美沙酮治疗中重度癌性疼痛安全有效,不良反应发生率较低,能够明显提高患者的生活质量。

Objective To observe the clinical effect,adverse reaction,and improvement of patient′ s living quality of methadone hydrochloride tablet（methadone） treating moderate and severe cancer pain. Methods Forty-two patients suffering from moderate or severe cancer pain were treated by methadone at an initial dosage of 5 mg/12 h.According to severity of pain,the dosage of methadone was adjusted until these patients didn′t feel pain or basically had no sensation of pain.The course of treatment for each participant lasted at least 15 days.At the same time,pain relief and quality of life were scored,and adverse reaction were observed. Results After 42 patients were given the individualized drug administration,the final dosage was set from 5 to 70 mg,at an interval of 12 h.After taking methadone,the vast majority of patients with pain was more than significantly alleviate,and the total alleviation rate of pain was 90.5%,of which complete alleviation in 11 cases（26.2%） and obvious relief in 27 cases（64.3%）.The alleviation rate of pain in moderate degree was 93.8%,while for severe pain,the alleviation rate was 88.5%.Before treatment,the mean KPS score was 50 points,after taking methadone,the mean KPS score reached 75 points,the quality of life was greatly improved（P〈0.05）.Based on KPS score, great improvement was in 9 cases（21.4%）,improvement in 13（31.0%）,and stabilization in 20（47.6%）,no case occurred with scoring decreasing.There were few adverse reactions that were quite slight. Conclusion Methadone treating moderate and severe pain is safe and effective with low incidence rate of adverse reactions,it can remarkably improve patient′s life of quality.