门诊癌性疼痛患者强阿片类药物应用的疗效分析

Therapy effect analysis of strong opioid drugs in patients with cancer pain in outpatient department

目的探讨门诊癌性疼痛患者强阿片类药物使用情况,改善癌性疼痛药物治疗的规范性及效果。方法选择2017年6月至2017年9月在江苏省肿瘤医院镇痛门诊首次就诊并符合下述入组条件的患者为研究对象:门诊治疗患者;NRS评分≥4分;治疗周期≥1个月且耐受阿片类药物治疗;有病理结果确诊依据,肿瘤分期为Ⅲ期~Ⅳ期,不再进行根治性治疗。根据世界卫生组织三阶梯止痛治疗原则及《NCCN成人癌性疼痛临床实践指南》要求使用阿片类药物,并对药物剂量、使用效果、不良反应等情况进行分析。结果共入组40例患者,患者疼痛缓解后吗啡日剂量为40~600 mg。神经病理性疼痛和混合性疼痛患者吗啡日均用量较内脏痛和躯体痛患者大,两者比较差异有统计学意义(P<0.05)。阿片类药物对所有癌性疼痛均有效,但对躯体痛疗效最明显。药物主要不良反应有:便秘(57.5%)、恶心呕吐(15.0%)、排尿困难(7.5%)和头晕(5.0%)等。结论癌性疼痛是一种总疼痛,多模式干预为最佳治疗策略,强阿片药物治疗癌性内脏痛效果明显,药物滴定及动态评估是提高疗效的重要环节,另外,门诊癌痛患者定期随访不可或缺,要充分体现全程管理理念,不断提高患者生活质量。

ObjectiveTo investigate and analyze the use of strong opioid drugs in 40 patients withcancer pain, and to improve the standardization and effectiveness of the drug treatment. MethodsA total of 40patients who visited our hospital for the first time during June 2017 to September 2017 were randomly selected.The criteria for selection of cases included： ① the outpatient treatment of patients with cancer pain; ② cancerpain NRS score ≥4 points （severe pain）; ③ the treatment cycle≥1 month and tolerance to opioids; ④ the di-agnosis was based on the pathological results, and the tumor stage was stage Ⅲ to Ⅳ, and no radical treatmentwas performed. According to the WHO three-step analgesic ladder principle and NCCN adult cancer pain clinical practice guideline, 40 outpatients with cancer pain were used strong opioid drugs and the dosages ofdrug, effects and adverse reactions were analyzed. ResultsA total of 40 patients were enrolled in this study.The daily dosage of morphine for pain relief was 40.600 mg. The daily dosage of neuropathic pain and mixedpain was more than somatic pain and visceral pain （P〈0.05）, opioid drugs were effective in various types ofcancer pain, but somatic pain treatment were the most obvious effect. The main adverse reactions were constipa.tion （57.5%）, nausea and vomiting （15%）, dysuria （7.5%） and dizziness （5%）. Conclusions Cancerpain is a kind of total pain, multi.mode intervention is the best treatment strategy, The effect of strong opioiddrugs on the treatment of cancer visceral pain is obvious. During the process of the outpatient patients with canc.er pain, grasping the titration tools and dynamic evaluation and carrying out outpatient follow.up work were im.portant to embody the whole process management, improve quality of life of patients.