肿瘤外科医生对癌痛治疗和吗啡临床应用的认知调查

Cognition of Cancer Pain Treatment and Clinical Application of Morphine of Oncology Surgeons

目的了解肿瘤外科医生对癌痛治疗和吗啡临床应用的认知情况,并探讨制约吗啡临床应用的消极因素。方法鉴于天津医科大学肿瘤医院是我国大型肿瘤专科医院,本研究于2014年1月选取天津医科大学肿瘤医院肿瘤外科医生85例进行问卷调查,问卷内容除一般情况外,主要分为3部分:(1)对WHO"癌症三阶梯止痛指导原则"的了解程度、用药习惯及对镇痛药物成瘾性的认知情况;(2)有关癌痛治疗和吗啡临床应用的基本知识;(3)影响吗啡临床应用的因素及其影响程度。共发放问卷85份,回收有效问卷72份,有效回收率为84.7%。结果 59.7%(43/72)的肿瘤外科医生表示很明确WHO"癌症三阶梯止痛指导原则"。28.9%(33/72)的肿瘤外科医生首选吗啡控释片治疗重度癌痛,22.8%(26/72)首选哌替啶治疗重度癌痛。58.3%(42/72)的肿瘤外科医生认为哌替啶的成瘾性最大,34.7%(25/72)认为吗啡针的成瘾性最大。有关癌痛治疗和吗啡临床应用基本知识的总体正确答题率为59.2%(341/576),其中"吗啡应用的目的"的得分率为36.1%(468/1 296)。不同职称肿瘤外科医生有关癌痛治疗和吗啡临床应用的基本知识得分间差异无统计学意义(P>0.05);而是否接受过相关培训的肿瘤外科医生有关癌痛治疗和吗啡临床应用的基本知识得分间差异有统计学意义(P<0.05)。38.9%(28/72)的肿瘤外科医生认为"医务人员是否接受镇痛治疗的专业培训"对吗啡的临床应用影响很大,其中"医务人员是否接受镇痛治疗的专业培训""对药物成瘾性的顾虑""担心药物不良反应""医疗卫生管理部门对吗啡的使用限制"的影响得分分别为3.1、2.9、2.9、2.9分。结论肿瘤外科医生在癌痛治疗和吗啡临床应用方面存在认知不足,亟须开展相关专业培训来改善癌痛治疗和医用吗啡现况。

Objective To study the cognition of cancer pain treatment and clinical application of morphine of oncology surgeons,and explore the negative factors that restrict the clinical application of morphine. Methods Considering that Tianjin Medical University Cancer Institute and Hospital is China′s large - scale tumor hospital,this study selected 85 oncology surgeons from Tianjin Medical University Cancer Institute and Hospital in January 2014 to do a questionnaire survey. Besides general data of the questionnaire,the contents of the questionnaire were divided into three parts：（1）the comprehensive degree of the ＂ three- step analgesic guideline of cancer＂ of WHO,drug - use habits and cognition of the addiction of analgesic drugs;（2）basic knowledge of cancer pain treatment and clinical application of morphine; （3）factors that affect the clinical application of morphine and their impacts. A total of 85 questionnaires were sent out and 72 valid questionnaires were got. The effective response rate was 84. 7% . Results 59. 7% （43 / 72）of the tumor surgeons were clear about the ＂ three - step analgesic guideline of cancer＂ of WHO. In the treatment of severe cancer pain,28. 9% （33 / 72）of the tumor surgeons preferred morphine controlled -release tablets,while 22. 8% （26 / 72）preferred pethidine. 58. 3% （42 / 72）of the tumor surgeons believed that pethidine had the strongest addiction,34. 7% （25 / 72）argued that morphine injection had the strongest addiction. The overall correct answer rate of basic knowledge of cancer pain treatment and clinical application of morphine was 59. 2% （341 / 576）,and the scoring rate of the purpose of applying morphine was 36. 1% （468 / 1296）. There was no significant difference in the scores of basic knowledge about cancer pain treatment and clinical application of morphine among tumor surgeons of different titles （P 〉 0. 05）, while there was significant difference in the scores of basic knowledge about cancer pain treatment and clinical application of morphine among tumor surgeons receiving relevant training or not （P 〈 0. 05）. 38. 9% （28 / 72）of the tumor surgeons thought that ＂ whether the medical staff receiving professional training of analgesic treatment or not＂ had great effects on the clinical application of morphine,and the scores of the effects of ＂ whether the medical staff accepting professional training of analgesic treatment＂,＂ concerns about drug addiction＂,＂ worrying about adverse drug reactions＂ and ＂ the use restrictions of morphine of medical and health management department authorities＂ were 3. 1,2. 9,2. 9,and 2. 9 respectively. Conclusion Oncology surgeons are lack of cognition in the treatment of cancer pain and clinical application of morphine,and thus it is in great need to carry out professional training to improve the treatment of cancer pain and medical morphine status.