盐酸羟考酮缓释片与口服即释吗啡片在慢性癌痛首次滴定治疗的临床比较

Oxycodone hydrochloride zyban compare with morphine hydrochloride tablets in the treatment of chronic pain titration

目的根据NCCN成人癌痛临床实践指南的要求,推荐首次使用阿片类药物的患者进行阿片类药物的滴定,推荐的滴定方案有盐酸羟考酮缓释片(长效)及口服即释吗啡(短效)2种滴定方案,确定2种方法的优劣。方法对60例癌痛患者对2种滴定方案在临床止痛疗效、不良反应及额外给药次数等方面进行比较。结果盐酸羟考酮缓释片滴定组(总缓解率93.3%)在疗效上与口服吗啡滴定组(96.6%)差异无统计学意义,不良反应方面:便秘、排尿困难及头晕等不良反应,2组差异无统计学意义。但口服吗啡组在恶心等不良反应方面,人数(15人)明显较盐酸羟考酮缓释片组(6人)为多,且口服吗啡组在给药2次及3次以上人数(10人)明显较盐酸羟考酮缓释片组(3人)多,差异有统计学意义。结论盐酸羟考酮缓释片相比于口服吗啡,止痛疗效相当,但不良反应及给药次数均优于口服吗啡,患者耐受性更佳,更适合临床滴定观察。

Objective To determine the advantages and disadvantages of titration solution with oxycodone hydrochlo- ride zyban （long-term） and morphine hydrochloride tablets （short-term）, in patients with first use of opioids for the titra- tion of opioid drugs, according to the requirements of adult pain NCCN clinical guidelines. Methods We analyzed 60 patients with cancer pain to compare the 2 titration solution, observed clinical analgesic efficacy and adverse reactions and dosing frequencies. Results There was no difference in the curative effect between the oxycodone hydrochloride zyban group （the total response rate of 93.3%） and the morphine hydrochloride group （96.6%）. The adverse reaction included constipation, dysuria and dizziness. There was no significant difference between the 2 groups. But patients with nausea and other adverse reactions varied significantly in the oxycodone hydrochloride （15 people） zyban group and the morphine hydrochloride tablets group （6 people ）. The morphine hydrochloride tablets group when dosing frequency at 2 times and more than 3 times （10 people） had significant difference compared with the oxycodone hy- drochloride zyban group （3 people）. Conclusion Oxycodone hydrochloride zyban and morphine hydrochloride tablets have similar curative effect. Oxycodone hydrochloride zyban is better than morphine hydrochloride tablets as to adverse reactions and drug delivery frequency, which is more suitable in patient tolerance and clinical observation titration.