2015与2010年版NCCN成人癌痛临床实践指南的比较

NCCN Adult Cancer Pain Clinical Practice Guideline: 2015 version vs 2010 version

目的:比较2015与2010年版美国国家癌症综合网(National Comprehensive Cancer Network,NCCN)成人癌痛临床实践指南,为临床癌痛治疗提供最新参考依据。方法 :比较2015与2010年版NCCN成人癌痛临床实践指南,对更新要点进行总结。结果 :2015年版美国NCCN成人癌痛临床实践指南与2010年版指南相比,有较多更新。针对未使用过阿片类药物的患者,在发生任何程度的疼痛时,都可考虑选用非甾体类抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)或对乙酰氨基酚;在剂量增减或剂量换算方面的更新较多;混合激动-拮抗剂、部分激动剂和氯胺酮的使用受到一定的限制;建议H2受体拮抗剂和胆碱能拮抗剂可用于肠梗阻;对于不良反应的处理,新增便秘时可换用芬太尼或美沙酮,肠梗阻时可使用奥氮平,过敏时可使用羟嗪;建议评估患者和照顾者的滥用/误用药物风险。结论 :通过对2015年版NCCN成人癌痛临床实践指南进行解读,可以更新癌痛诊治理念,建议采用药物与非药物治疗相结合的方法治疗癌痛,以适应患者的个体化需求。

Objective： To compare 2015 Comprehensive Cancer Network Practice Guideline to provide new adult cancer pain. and 2010 versions of National （NCCN） Adult Cancer Pain Clinical evidence for clinical intervention of Methods： Summarize the main points of the updates in 2015 NCCN Adult Cancer Pain Clinical Practice Guideline through comparing 2015 version with 2010 version. Results： There are many updates in 2015 NCCN Adult Cancer Pain Clinical Practice Guideline. The opioid-naive patients could consider non-steroidal anti- inflammatory drugs （NASIDs） or acetaminophen; the calculation method for dosage increase, reduction or conversion is different from 2010 version. There are some limitations in the use of mixed-mechanism drugs, partial agonists and ketamin; H2 blockers and anticholinergics could be used in bowel obstruction; fentanyl or methadone is preferred in constipation; olanzapine could be used in obstruction; hydroxyzine could be used in allergies. The risk factors of opioid abuse/misuse of patients and family/caregivers should be evaluated. Conclusion： Through the interpretation of the 2015 NCCN Adult Cancer Pain Clinical Practice Guideline, the understanding of the concept of diagnosis and treatment of cancer pain is improved. It is suggested that combination of drug therapy and non-drug therapy can be adopted to relieve the cancer pain and meet the individual needs of the patients.