吗啡静脉给药用于肿瘤重度癌痛的疗效分析

Analysis on intravenous administration of morphine in the treatment of severe pain in tumors

目的观察静脉注射吗啡治疗肿瘤重度疼痛的临床疗效和安全性。方法选择我科2008~2017年32例NRS≥7分的不能口服药物的肿瘤重度疼痛患者,将伴有发热者或经换算芬太尼剂量较大,且超过8.4 mg×10贴/72 h时的13例患者纳入吗啡组(静脉持续泵入吗啡),无明显发热或经换算芬太尼剂量未超过8.4 mg×10贴/72 h的19例纳入芬太尼组(芬太尼透皮贴)。比较两组患者的镇痛疗效及不良反应发生情况。结果治疗后,吗啡组和芬太尼组的NRS分别为(2.3±0.6)分和(2.8±0.9)分,较治疗前明显下降(P<0.05),两组间差异无统计学意义(P>0.05)。吗啡组及芬太尼组的治疗有效率(CR+PR)分别为69.2%和68.4%,差异无统计学意义(P=0.93)。两组的不良反应主要在恶心呕吐、便秘、头晕及排尿困难等方面,经对症处理后可缓解,差异无统计学意义(P>0.05)。结论对于重度癌痛患者而言,吗啡静脉给药也许是一项较好的治疗选择。

Objective To observe the clinical efficacy and safety of intravenous injection of morphine in the treatment of severe tumor pain. Methods A total of 32 patients with tumor severe pain and NRS ≥ 7 who were not able to be given oral medication in our department from 2008 to 2017 were selected. 13 patients with fever or converted dosage of fentanyl over 8.4 mg×10 patches/72 hours were assigned to the morphine group （continuous intravenous morphine infu- sion）. 19 patients with no fever or converted dosage of fentanyl not exceeding 8.4 mg×10 patches/72 hours were as- signed to the fentanyl group （fentanyl transdermal patch）. The analgesic efficacy and adverse reactions were observed and compared between the two groups. Results After treatment, the NRS in morphine group and fentanyl group were （2.3±0.6） points and（2.8±0.9） points respectively, which were significantly lower than those before treatment（P〈0.05）, and there was no statistically significant difference between the two groups（P〉0.05）. The treatment effective rates of （CR＋PR） in morphine group and fentanyl group were 69.2% and 68.4% respectively, with no statistically significant dif- ference（P=0.93）. The adverse reactions were mainly in nausea and vomiting, constipation, dizziness and urination diffi- culties in both groups. After symptomatic treatment, the reactions could be alleviated, with no significant difference（P〉 0.05）. Conclusion Intravenous morphine administration may be a favorable treatment option for the patients with severe cancer pain.