硫酸吗啡缓释片、盐酸羟考酮缓释片与芬太尼透皮贴剂治疗癌痛引起便秘的风险比较

Comparison of Constipation Risk of Morphine Sulfate Sustained-release Tablets,Oxycodone Hydrochloride Sustained-release Tablets and Fentanyl Transdermal Patch in the Treatment of Cancer Pain

目的:比较硫酸吗啡缓释片、盐酸羟考酮缓释片与芬太尼透皮贴剂在癌痛治疗中引起便秘的风险。方法:将927例癌痛患者按所用药物分为A组(450例,硫酸吗啡缓释片)、B组(290例,盐酸羟考酮缓释片)、C组(187例,芬太尼透皮贴剂),进行回顾性分析。A组起始剂量60 mg,每12 h口服1次;B组起始剂量30 mg,每12 h口服1次;C组起始剂量4.2 mg,每72 h外用1贴。3组患者均根据疼痛控制情况调整剂量增幅。比较3组患者在基础等效剂量下治疗初期便秘发生率、随治疗时间延长便秘发生率以及随等效剂量的增加便秘发生率的变化。结果:3组患者在基础等效剂量下治疗2周便秘发生率A组>B组>C组,3组间比较差异均有统计学意义(P<0.05);3组患者在基础等效剂量下随治疗时间延长便秘发生率变化不大,3组平均下降幅度差异很小;3组患者随等效剂量的增加便秘发生率均有所增加,A、B组增幅大于C组。结论:芬太尼透皮贴剂在癌痛治疗中引起便秘的风险低于硫酸吗啡缓释片和盐酸羟考酮缓释片。

OBJECTIVE： To compare the constipation risk of Morphine sulfate sustained-release tablets, Oxycodone hydrochlo- ride sustained-release tablets and Fentanyl transdermal patch in the treatment of cancer pain. METHODS： 927 patients with cancer pain were divided into group A （450 cases, Morphine sulfate sustained-release tablets）, group B （290 cases, Oxycodone hydrochloride sustained-release tablets） and group C （187 cases, Fentanyl transdermal patch）. Group A was given relevant medicine with initial dose of 60 mg every 12 h, po; group B with initial dose of 30 mg every 12 h, po; group C with initial dose of 4.2 mg every 72 h, external use. The drug dosages of 3 groups were adjusted according to the situation of pain control. The incidences of constipation in initial stage of basic equivalent dose therapy, its change as time passed and as equivalent dose increased were compared among 3 groups. RESULTS ： The incidence of constipation after 2 weeks of treatment was in descending order as follows： group A〉group B〉group C; there was statistical significance （P〈0.05）. There was no great change in the incidence of constipation as time passed, and the decrease of incidence had small difference among 3 groups. The incidence of constipation in 3 groups in- creased as equivalent dose increased, and the increase of group A and B were greater than that of group C. CONCLUSIONS： The risk of constipation induced by Fentangl transdermal patch is lower than that induced by Morphine sulfate sustained-release tablets and Oxycodone hydrochloride sustained-release tablets.