我国阿片类镇痛药物临床使用现状分析

Analysis of the Clinical Use of Opioid Analgesics in China

目的:了解我国阿片类镇痛药物使用现况及变化趋势,及阿片类镇痛药物治疗中、重度疼痛的消耗充分性水平。方法:采用回顾性分析方法,分析2006~2016年我国阿片类镇痛药物的消耗频度(DDDs)及变化趋势;采用计算消耗量充足性测量(ACM)的方法测算我国全人群中、重度疼痛吗啡治疗需要量,评价我国阿片类镇痛药物治疗中、重度疼痛的消耗充分性,并与其他国家和地区进行横向比较。结果:2006~2016年,我国阿片类镇痛药物消耗频度(DDDs)从9.7亿DDDs增加到37.03亿DDDs,增速先快后缓,尤以2013年增长较为明显,2015年稍有下降。基于中国医院药品统计报告(CHPA)计算的,反映我国阿片类镇痛药物治疗中、重度疼痛消耗充分性的ACM值,从2006年的0.003 4上升到2016年的0.010 2,国际相对水平一直处于"极差"。基于国际麻醉药品管制局(INCB)统计数据计算的ACM值,从2006年的0.004 9上升到2013年的0.01 16(国际相对水平仍为"极差"),后持续走低。结论:我国阿片类镇痛药物治疗中、重度疼痛消耗虽然一直在增长,但整体消耗不足,与国际消耗水平有较大差距,存在医务人员、患者、监管体系和社会文化等多层面的原因。应从加强医务人员培训和患者教育,通过大众媒体传播疼痛管理的正确科学理念,鼓励医患间交流与沟通,完善特殊药品监管体系,改进医疗卫生体制,平衡严格监管、防止滥用的目标与满足人民不断增长的对美好生活需要的目标等方面改进。

Objective： To learn the level and trend of opioid analgesics clinical use and the consumption adequacy of opioid analgesic treatment of moderate to severe pain, as well as the pain control level of China with international comparisons. Methods：A retrospective analysis was carried out to show the consumption frequency （DDDs） and the trend of opioid analgesics clinical use in China from 2006 to 2016. Adequacy of consumption measure （ACM） was used to gauge the amount of needed morphine equivalents and the overall adequacy of opioid analgesic treatment of moderate to severe pain in China, and compared with international data. Results ：The consumption frequency of opioid analgesics （DDDs） in China increased from 0.97 billion DDDs in 2006 to 37.03 billion DDDs in 2016. The growth rate was faster at first, especially in 2013, then the growth slowed down, and decreased slightly in 2015. The ACM value based on hospital procurement data increased from 0.003 4 in 2006 to 0. 010 2 in 2016, which has always been at the international comparative level of ＂very poor＂. The ACM value based on the International Narcotics Control Board statistics increased from 0. 004 9 in 2006 to 0.011 6 in 2013 （ still ＂very poor＂ ）, followed with continued drops. Conclusion： The consumption of opioid analgesics for treatment of moderate to severe pain in China has always been inadequate during 2006-2016. There has been a huge gap between China and the international level. There are many reasons behind this, which lie in different aspects, including medical staff, patients and the public, health systems and social ＆ cultural aspects. It is necessary to strengthen the train- ing and education of the medical staff and the patients, to use mass media to disseminate scientific knowledge of pain man- agement, to encourage communications between doctors and patients, to improve regulatory system for controlled medicines and the overall health systems, and to balance the regulatory goal of avoidance of abuse, and the goal of meeting the in- creasing needs of the people for better life.