癌痛规范化治疗提高中重度癌痛患者生活质量的临床及护理分析

Efficacy of standardized cancer pain treatment for improving quality of life in patients with severe cancer pain

目的探讨癌痛规范化治疗对中重度癌痛患者生活质量及临床效果的影响分析。方法采用患者自身前后对照、前瞻性研究方法,以2016年1月至2017年6月陆军军医大学第三附属医院(野战外科研究所)肿瘤中心收治的晚期癌症并伴有中重度癌痛的110例患者为研究对象,实施以疼痛的"常规、量化、全面、动态"评估、规范化综合治疗、不良反应防治、健康教育和随访为护理要点的癌痛规范化治疗,以数字疼痛分级法(numerical rating scale,NRS)、生活质量评分(quality of life,QOL)和体能状况Karn of sky评分法(KPS)、不良反应发生率作为评价指标,比较分析患者实施癌痛规范化治疗前后生活质量的变化。结果中重度癌痛患者在实施规范化治疗后,92.7%患者的疼痛强度降低至轻度疼痛或无痛;不良反应(便秘、头晕、恶心呕吐、嗜睡和尿潴留)发生率明显降低(P<0.05);生活质量评分的12项内容均明显改善,平均QOL评分和KPS评分分别为49.91±7.64和84.51±3.56,显著高于规范化治疗前的29.40±10.38和68.42±9.23,差异有统计学意义(P<0.05)。结论实施癌痛规范化治疗能有效缓解晚期癌症患者的疼痛,降低药物的不良反应发生率,改善体能状态,提高生活质量。

Objective To evaluate the effect of standardized cancer pain treatment for improving the quality of life（QOL） in the patients with severe cancer pain. Methods This prospective,self-controlled study was conducted among 110 terminal cancer patients with severe pain hospitalized in our center between January,2016 and June, 2017. The patients received standardized pain management with routine,quantitative,comprehensive and dynamic pain assessment,standardized comprehensive treatment,adverse effect control,health education and follow-up. The changes in the patients＇ QOL after the implementation of standardized treatment were assessed in terms of changes in numerical rating scale（NRS） scores,QOL scores,Karn of sky performance status（KPS） and the incidence of adverse reactions. Results After the implementation of the standardized pain management,92. 7% of the patients with moderate or severe cancer pain reported obviously reduced pain intensity to mild pain or total pain relief with also significantly reduced incidences of adverse reactions（constipation,dizziness,nausea,vomiting,drowsiness and urinary retention）（P〈0. 05）. The standardized pain management achieved significant improvements in the scores of the 12 quality of life items,and significantly reduced the average QOL score（from 49. 91 ± 7. 64 to 29. 40 ± 10. 38）and KPS score（from 84. 51 ± 3. 56 to 68. 42 ± 9. 23） of the patients（P〈0. 05）. Conclusion The standardized cancer pain treatment can effectively reduce the pain level,reduce the incidence of adverse reactions,and improve the physical condition and quality of life of patients with terminal cancer.