晚期癌痛患者不同方式大剂量吗啡持续给药疗效的前瞻性研究

Efficacy of High-dose Morphine with Different Continuous Administration Routes: a Prospective Study in Patients with Advanced Cancer Pain

目的:比较晚期癌症患者静脉与皮下两种给药途径持续应用吗啡镇痛的疗效,探讨大剂量吗啡不同方式给药的适应证。方法:采用前瞻性方法,收集符合条件的晚期癌痛患者46例,根据使用患者自控镇痛(PCA)泵给药方式分为静脉组和皮下组,记录滴定过程中疼痛评估结果,比较两组镇痛效果及安全性等指标。结果:两组患者需要解救的爆发痛次数、滴定过程中吗啡PCA泵给药速度调整次数、阿片转换后止痛有效率以及阿片相关性不良反应发生率等指标比较,差异均无统计学意义(P>0.05)。达到稳定止痛时,皮下组患者每日等效吗啡口服总量明显高于静脉组(P<0.05)。结论:吗啡注射液经静脉或经皮下持续注射均可快速、安全、有效止痛。在止痛疗效相同的前提下,可根据患者所需吗啡剂量、原发疾病对活动的影响程度及个人意愿等选择合适的给药途径。

Objective： To compare the efficacy of morphine with intravenous injection and subcutaneous injection in the treatment of advanced cancer,and explore the indications of different drug delivery methods for high-dose morphine. Methods： A prospective study was performed,and 46 cases of patients with advanced cancer pain were collected and divided into intravenous group and subcutaneous group according to the administration route. Pain was assessed during the administration,and the analgesic efficiency and the incidence of adverse reactions were observed to compare the efficacy and safety of two different ways to give high-dose morphine. Results： No statistically significant differences were found in the number of outbreaks needed to be rescued,the frequency of morphine-induced drug delivery,the efficiency of analgesia after opioid transfer,and the incidence of opioid-related side effects between the groups（ P 0. 05）. The dose of morphine in the subcutaneous group was higher than that of the intravenous group（ P 0. 05）. Conclusion： The continuous administration of morphine with intravenous injection and subcutaneous injection can quickly,safely and effectively relieve pain. With the same analgesic efficacy,patients can choose appropriate administration route according to the dose of morphine,the influence degree of primary diseases and the individual will.