比较芬太尼与布托啡诺对吗啡不耐受的晚期中重度癌痛患者的镇痛疗效及相关指标的影响

Comparison of Fentanyl Transdermal Patch and Butorphanol Nasal Spray for Morphine Intolerant Patients with Advanced Cancer and Effects on Related Indicators

目的:比较芬太尼透皮贴剂与布托啡诺鼻喷剂对吗啡不耐受的晚期中重度癌痛患者的镇痛疗效及相关指标的影响。方法:64例口服吗啡镇痛后存在对吗啡不耐受的晚期中重度癌痛患者随机分为芬太尼组(32例)和布托啡诺组(32例)。所有患者按口服吗啡剂量为参考换算芬太尼透皮贴剂与布托啡诺鼻喷剂的使用剂量:口服吗啡100 mg/d=芬太尼透皮贴剂1 mg/d=布托啡诺鼻喷剂1 mg/d。芬太尼组患者给予芬太尼透皮贴剂1贴,每72 h更换1次。布托啡诺组患者给予酒石酸布托啡诺鼻喷剂1喷,每24 h1喷。镇痛效果控制不佳者加用芬太尼静脉自控镇痛,至患者疼痛控制且不良反应缓解,若出现不可耐受的不良反应则在自控镇痛时减少剂量。两组均连续用药10 d。观察两组患者的镇痛效果、治疗前后疼痛评分、5-羟色胺(5-HT)水平、去甲肾上腺素(NE)水平、生存质量(一般状态、日常活动、情绪、行走、社交、睡眠、娱乐)评分及不良反应发生情况。结果:芬太尼组患者镇痛总有效率显著高于布托啡诺组,差异有统计学意义(P<0.05)。治疗前,两组患者疼痛评分、5-NT水平、NE水平、生存质量评分、不良反应发生率比较,差异均无统计学意义(P>0.05)。治疗后,两组患者疼痛评分、5-NT水平、NE水平、生存质量评分、不良反应发生率均显著低于同组治疗前,且芬太尼组患者疼痛评分、5-NT水平、NE水平、一般状态评分、日常活动评分、情绪评分、娱乐评分、头晕嗜睡发生率均低于布托啡诺组,差异均有统计学意义(P<0.05)。结论:芬太尼透皮贴剂用于对吗啡不耐受的晚期中重度癌痛患者在镇痛疗效、降低疼痛介质水平、改善生存质量及减少不良反应发生率方面均显著优于布托啡诺鼻喷剂。

OBJECTIVE： To observe the analgesic efficacy of Fentanyl transdermal patch versus Butorphanol nasal spray for morphine intolerant patients with advanced cancer and its effect on related indicators. METHODS： 64 morphine intolerant pa- tients with advanced cancer were randomly divided into fentanyl group （32 cases） and butorphanol group （32 cases）. Based on the dose of oral morphine, all patients changed the dose of Fentanyl transdermal patch and Butorphanol nasal spray. Morphine dose 100 mg/d=Fentanyl transdermal patch 1 mg/d=Butorphanol nasal spray 1 mg/d. Fentanyl group was given 1 Fentanyl trans- dermal patch, replaced once every 72 h; butorphanol group was given 1 Butorphanol tartrate nasal spray, sprayed every 24 h. If the analgesic effect was poor, then self-controlled with fentanyl intravenously for analgesia, until it was controlled and adverse reac- tion relieved, and dose was decreased in self-controlled analgesia if there were intolerable adverse reactions. Both groups were giv- en continuous medication for 10 d. Analgesic effects, pain scores, 5-hydroxytryptamine （5-HT）, norepinephrine （NE）, and scores of life quality （general status, daily activities, emotions, walk, social eontact, sleep） before and after treatment, and the incidence of adverse reactions in 2 groups were observed. RESULTS： The total effective rate in fentanyl group was significantly higher than bu- torphanol group, with statistic significance （P〈0.05）. Before treatment, there were no significant differences in pain scores, 5-HT, NE level, scores of life quality and the incidence of adverse reactions in 2 groups （P〉0.05）. After treatment, pain scores, 5-HT, NE level, scores of life quality and the incidence of adverse reactions in 2 groups were significantly lower than before, pain scores, 5-NT, NE level, general status scores, daily activities scores, emotions scores and entertainment scores and the incidence of dizziness and sleepiness in fentanyl group were significantly lower than butorphanol group, with statistic significances （P〈 0.05）. CONCLUSIONS： Fentanyl transdermal patch is superior to Butorphanol nasal spray in the treatment of morphine intolerant patients with advanced cancer in terms of analgesic efficacy, reducing pain level, improving life quality and reducing the incidence of adverse reactions.