恶性肿瘤骨转移疼痛患者治疗及预后的临床分析

Clinical Analysis of Treatment and Prognosis of Patients with Pain Caused by Malignant Bone Metastasis

目的分析骨转移患者骨痛发病特点、内科治疗效果及预后,并对镇痛药物用药合理性进行分析,以提高临床对骨转移疼痛的诊治水平。方法对123例伴有疼痛的恶性肿瘤骨转移患者进行规范三阶梯止痛治疗及抗肿瘤治疗,并对其临床特征进行回顾性分析。结果总疼痛缓解率85.4%,疼痛程度明显减轻(P<0.05)。各麻醉类药物DUI值均接近1,用药趋向合理。Kaplan-Meier生存分析显示,中度疼痛者生存明显优于重度疼痛者(P=0.015);疼痛明显缓解者生存明显优于未明显缓解者(P=0.021);无内脏转移者生存优于伴有内脏转移者(P=0.000)。COX多因素分析结果显示,疼痛程度、是否内脏转移是影响预后的独立危险因素。结论规范治疗可使多数骨转移疼痛患者症状改善,并在一定程度上延长生存时间。阿片类药物对中重度疼痛具有理想的止痛效果,不良反应可以耐受。

Objective To analyze the clinical features,therapeutic effect and prognosis in patients with bone pain induced by malignant bone me-tastasis as well as the rationality of analgesic application,so as to improve the level of diagnosis and treatment for metastatic bone pain. Methods Totally 123 patients with pain due to malignant bone metastasis received antitumor therapy and analgesic therapy based on standardized three-step guidelines. Their clinical characteristics were retrospectively analyzed. Results The total pain relief rate was 85.4%and the pain was significantly relieved（P〈0.05）. The DUI value of each narcotic agent was close to 1 and the application of narcotic agents tended to be rational. The Kaplan-Meier survival analysis showed that patients with moderate pain had longer survival time than those with severe pain（P=0.015）. The survival rate of patients with significant pain relief after treatment was higher than those unrelieved（P=0.021）. The survival rate of patients without visceral me-tastasis was higher than those with visceral metastasis（P=0.000）. The COX multivariate analysis indicated that the pain intensity and visceral me-tastasis were independent risk factors influencing patient prognosis. Conclusion Standard treatment can improve symptoms in most patients with bone metastasis and prolong survival time. Opioids have satisfactory analgesic effect for moderate to severe pain and the adverse reactions can be tol-erated.