硫酸吗啡控释片联合丁丙诺啡舌下含片用于中重度癌痛患者的疗效观察

Efficacy of combination of morphine sulfate controlled-release tablet and buprenorphine sublingual tablet in moderate to severe cancer pain patient

目的观察硫酸吗啡控释片联合丁丙诺啡治疗中重度癌痛的临床疗效，探讨临床合理治疗晚期癌痛的有效方法。方法选择止痛门诊的癌症晚期疼痛患者，视觉模拟评分（visual analog scale，VAS）〉3分，用单一吗啡控释片治疗后，VAS评分仍〉3分，止痛效果欠佳的150例患者，采用随机数字表法分为两组，每组75例：吗啡控释片组（M组），使用单一硫酸吗啡控释片；吗啡控释片联合丁丙诺啡组（MB组），采用硫酸吗啡控释片±丁丙诺啡。通过对两组止痛效果、副作用、生活质量及患者对镇痛治疗满意度的比较，探讨联合用药治疗晚期癌痛的优点和可行性。结果联合用药较单一用药镇痛效果显著，中重度VAS评分例数明显减少（M组／MB组：中度26／10，重度4／0）（P〈0．05）；恶心、呕吐等副作用的发生例数明显减少（M组／MB组：恶性呕吐12／2，嗜睡4／2，呼吸抑制9／4，排尿困难8／3，便秘8／4）（P〈0．05）；患者对镇痛效果的满意度明显提高（M组／MB组：很满意10／14，满意36／47）（P〈0．05）；生活质量明显改善[M组／MB组：睡眠（5．5±1．2）／（4．6±0．7），情绪（5．4±0．5）／（4．6±1．2），日常活动（5．1±0．4）／（4．9±0．5），社交活动（5．5±0．4）／（4．8±1．6）]（P〈0．05）。结论硫酸吗啡控释片联合丁丙诺啡治疗晚期癌痛可以提高镇痛效果，降低副作用的发生率，提高患者的生活质量。

Objective To investigate the efficacy of combination of morphine sulfate controlled-release tablet and buprenorphine sublingual tablet in patients With moderate to severe cancer pain, and explore effective analgesic therapies for advanced cancer pain patients. Methods One hundred ahd fifty patients with advanced cancer pain whose visual analog scale （VAS） scores were greater than 3 points and VAS scores were still greater than 3 points after treated with controlled-release tablet of morphine alone were randomly divided into two groups （n=75）： controlled-release morphine ~ablet alone group （M group ） and conbination use of controlled-release morphine tablet with buprenorphine tablet group （MB group）. Analgesic effect, adverse reactions, living quality and patient＇s satisfaction were compared. Results Compared with single usage of controlled-release tablet of morphine, the analgesic effect of combined therapy was significant, VAS score was significantly reduced （M group/MB group： M 26/10, S 4/0）（P〈0.05）. Nausea, vomiting and other adverse reactions decreased significantly （M group/MB group： nausea and vomiting 12/2, drowsiness 4/2, respiratory depression 9/4, dysuria 8/3, constipation 8/4）（P〈0.05 ）. Patient＇s satisfaction （M group/ MB group ： very satisfaction 10/14, satisfaction 36/47 ） （P〈0.05） and living quality [ M groUp/MB roup ： sleep（ 5.5±1.2）/（4.6±0.7 ）, Mood（5.4±0.5）/（4.6±1.2）, Daily activities（5.1±0.4）/（4.9±0.5）, Social activities（ 5.5±0.4 ）/（ 4.8±1.6 ） ] were significantly improved （P〈0.05）. Conclusions The joint application of morphine sulfate controlled-release tablet and buprenorphine Sublingual tablet was effective for advanced cancer pain. It can improve the potency of analgesia, reduce the incidence of adverse effects and improve the living quality of patients.