乳果糖预防阿片类药物致晚期泌尿系恶性肿瘤患者便秘的效果观察

Effect of lactulose on preventing opioid induced constipation in patients with advanced malignant urological tumor

目的观察预防性应用乳果糖对晚期泌尿系恶性肿瘤患者服用阿片类药物出现便秘的时间及程度的影响。方法纳入2010年1月至2014年12月辽宁省大连市中心医院需接受阿片类药物止痛治疗的晚期泌尿系恶性肿瘤患者53例，按随机数字表法分为乳果糖预防用药组（26例）和空白对照组（27例）。乳果糖预防用药组开始使用阿片类止痛药时即预防性使用乳果糖，10ml／次，1次／d，口服，直至出现便秘，如患者一直未出现便秘，预防用药最长时间不超过3周；空白对照组不预防性使用乳果糖。比较2组第1次便秘出现时间和便秘严重程度。结果乳果糖预防用药组中位第1次便秘出现时间明显长于空白对照组（18d比6d，P=0．001）；乳果糖预防用药组轻度便秘9例、中度便秘14例、重度便秘3例，空白对照组轻度便秘3例、中度便秘11例、重度便秘13例，乳果糖预防用药组便秘程度轻于空白对照组（P=0．008）。结论预防性应用乳果糖可明显延长接受阿片类药物止痛治疗的晚期泌尿系恶性肿瘤患者发生便秘的时间，并能减轻便秘的程度。

Objective To evaluate the effect of lactulose on preventing opioid induced constipation in patients with advanced malignant urological tumor. Methods Totally 53 patients with advanced malignant urological tumor who needed analgesic therapy with opioid drugs were randomly divided into prophylaxis group （26 cases） and control group （27 group）. Prophylaxis group received lactulose （ 10 ml/time, 1 time/d, oral） when opioid therapy began till constipation occurred （ the time was not more than 3 weeks if constipation did not occur） ; control group was not given laetulose. The first occurrence time of constipation and constipation degree were compared between groups. Results The median first occurrence time of constipation in prophylaxis group was significantly longer than that in control group （18 d vs 6 d, P = 0. 001 ）. The constipation degree in prophylaxis group （mild： 9 cases, middle： 14 cases, severe： 3 cases） was significantly lower than that in control group （mild： 3 cases, middle： 11 cases, severe： 13 cases ） （P = 0. 008 ）. Conclusion Preventive medication of lactulose can significantly lengthen the time of occurrence time of constipation and lighten the constipation degree in patients with advanced malignant urological tumor who receive opioid.