强阿片类药物对不同胃肠功能状态的晚期中-重度癌痛患者的镇痛效果观察

Clinical observation of analgesic effect of strong opioid drugs for moderate and severe cancer pain in patients with different gastrointestinal function

目的探讨强阿片类药物对不同胃肠功能状况的晚期中-重度癌痛患者的镇痛效果。方法选取本院收治的102例晚期中-重度癌痛患者,根据原发肿瘤发病部位,分为消化系统癌症组(46例)和非消化系统癌症组(56例)。再根据胃肠功能状态的不同,进一步分为排便间隔≤3天组和>3天组。所有患者均使用强阿片类药物进行镇痛治疗,比较两组在癌痛严重程度、癌痛类型、日均消耗吗啡当量、癌痛控制状况以及癌痛缓解度上的差异。结果消化系统癌症组和非消化系统癌症组疼痛控制总有效率分别为93.48%(43/46)和91.07%(51/56),两组差异无统计学意义(P>0.05)。消化系统癌症组中排便间隔>3天(69.57%vs.37.50%,P<0.01)和使用芬太尼透皮贴剂(63.04%vs.23.21%,P<0.01)的患者比例明显高于非消化系统癌症组,但其躯体痛患者比例低于非消化系统癌症组(50.0%vs.87.5%,P<0.01)。两组在重度疼痛患者比例、内脏痛、神经病理性疼痛和日均吗啡当量上比较无统计学差异(均P>0.05)。上述两组患者中排便间隔时间≤3天组的重度疼痛患者比例与排便间隔时间>3天组比较无统计学差异(均P>0.05),排便间隔≤3天组疼痛控制总有效率均显著高于排便间隔>3天组(均P<0.01),排便间隔≤3天组日均吗啡当量均显著低于排便间隔>3天患者(均P<0.01)。两者中排便间隔>3天组比较,重度疼痛、疼痛控制总有效率和日均吗啡当量均无显著性差异(均P>0.05)。结论晚期中-重度癌痛患者口服阿片类药物或使用芬太尼透皮贴剂可获得较好的疼痛控制效果,排便间隔时间>3天与镇痛效果呈负相关,消化系统癌症和排便间隔>3天的患者适宜接受芬太尼透皮贴剂作为主要维持用药。

[Abstract] Objective To investigate the analgesic effect of strong opioid drugs for moderate and severe cancer pain in patients with different gastrointestinal function. Methods One hundred and two advanced cancer patients with moderate and severe cancer pain were divided into digestive cancer group （n= 46） and non-digestive cancer group （n=56）, and then according to the different condition of gastrointestinal function, further divided into defecation interval less than 3 days group and more than 3 days group. All patients received analgesic treatment in our department. The proportion of severe pain, pain classification, morphine equivalent daily consumption, pain relief rate and total pain control efficiency were compared between the two groups. Results There was no significant difference in the total pain control efficiency between the digestive and non-digestive cancer groups （93.48% vs. 91.07%, P〉0.05）. The proportions of the patients with defecation interval more than 3 days （69.57% vs. 37.50% ,P〈0.01 ）, with using fentanyl patch （63.04% vs.23.21%,P〈0.01） were significantly higher in the digestive cancer group, while the proportion of somatic pain was lower in the digestive cancer group than those in the non-digestive cancer group （50.0% vs. 87.5% ,P〈0.01 ）. There were no significant differences in the proportion of patients with severe pain, visceral pain, neuropathic pain and daily morphine equivalent between the two groups （all P〉0.05）. The total pain control efficiency was significantly higher（all P〈O.01 ）, and morphine equivalent daily consumption was lower in the patients with defecation interval less than 3 days than those with defecation interval more than 3 days in both groups （all P〈0.01）. There were no significant differences in the proportion of severe pain, total pain control efficiency and morphine equivalent daily consumption in the patients with defecation interval more than 3 days between the two groups （all P〉0.05）. Conclusions Strong opioids or transdermal fentanyl patch can achieve better control effect for moderate and severe cancer pain. Defecation interval more than 3days is negatively associated with the analgesic effect. The terminal digestive cancer patients with defecation interval over 3 days were suitable for accepting fentanyl patch as main maintenance medication.