云浮地区癌症患者止痛药物使用情况分析

Analysis of analgesics administration condition for patients in Yunfu area

目的探讨云浮市人民医院肿瘤科癌痛患者止痛药物的使用情况。方法 80例符合研究标准的癌痛患者作为研究对象,分析癌痛患者疼痛等级、镇痛药物使用状况、镇痛效果与不良反应的发生情况等。结果 80例发生癌痛的肿瘤患者中,中度疼痛48例,占60.0%;重度疼痛32例,占40.0%。对于中度疼痛组,首选非甾体抗炎药进行镇痛,疗效不佳者使用弱阿片类药物或强阿片类药物进行镇痛,而对于重度疼痛者,则直接考虑使用强阿片类药物镇痛,少数配合非甾体类抗炎药物,以在避免药物耐受的基础上尽可能的提高镇痛效果。中度疼痛组在治疗48 h疼痛缓解情况明显优于重度疼痛组,差异具有统计学意义(P<0.05);两组患者治疗72 h后疼痛缓解情况比较差异无统计学意义(P>0.05)。治疗过程中,8例患者爆发疼痛,其中肝癌3例,肺癌4例,胃癌1例,在大剂量使用普通吗啡片后均较好地缓解了疼痛。80例患者用药前美国东部协作肿瘤组(ECOG)评分(3.34±1.31)分,出院时ECOG评分(1.35±0.82)分,出院时ECOG评分明显优于用药前,差异具有统计学意义(t=7.644,P<0.05)。中度与重度疼痛组患者出院时ECOG评分分别为(1.21±0.64)、(1.55±0.84)分,两组出院时ECOG评分均低于用药前(P<0.05),但重度疼痛组在出院时的ECOG评分仍较中度疼痛组差(t=2.052,P<0.05)。80例使用镇痛药物的患者中重度疼痛组累计11例(34.4%)患者发生了不良反应,而中度疼痛组有7例(14.6%)发生了不良反应,重度疼痛组不良反应发生率高于中度疼痛组,差异具有统计学意义(P<0.05)。结论对于中度以上的癌痛患者,合理使用强阿片类物质进行镇痛,能有效改善患者的疼痛情况,提高其体力活动能力,改善其生活质量。

Objective To investigate analgesics administration condition in cancer pain patients from department of oncology in Yunfu city people’s hospital.Methods There were80cancer pain patients meeting research standard as study subjects.Their pain degree,administration condition of analgesics,analgesic effect and adverse reactions were analyzed.Results Among80patients with cancer pain,there were48cases with moderate pain,accounting for60.0%,and32cases with severe pain,accounting for40.0%.Moderate pain group received initially non-steroid anti-inflammatory agent for analgesia,followed by additional weak opioid or strong opioiddrugs for poor-effect cases.Severe pain group received immediately strong opioid drug for analgesia with minoritycombination with non-steroid anti-inflammatory agent,in order to improve analgesic effect on the basis of preventingdrug resistance.The moderate pain group had obviously better pain relief condition in48h of treatment than thesevere pain group,and the difference had statistical significance(P<0.05).There was no statistically significantdifference of pain relief condition in72h of treatment between the two groups(P>0.05).During treatment,there were8patients with occurred pain,including3cases with liver cancer,4cases with lung cancer,and1case with stomachcancer.After administration of ordinary morphine tablets by large dose,their pain were relieved.The80patientshad Eastern Cooperative Oncology Group(ECOG)score as(3.34±1.31)points before medication and(1.35±0.82)points at discharge.Their ECOG score at discharge was obviously better than that at admission,and the differencehad statistical significance(t=7.644,P<0.05).The moderate pain group and the severe pain group had ECOG scoreat discharge respectively as(1.21±0.64)and(1.55±0.84)points,and both groups had lower ECOG scores thanthose before medication(P<0.05),while the severe pain group had worse ECOG score at discharge than the moderatepain group(t=2.052,P<0.05).Among the80patients receiving analgesics,there were11cases(34.4%)with adversereactions in the severe pain group and7cases(14.6%)with adverse reactions in the moderate pain group.The severepain group had higher incidence of adverse reactions than the moderate pain group,and the difference had statisticalsignificance(P<0.05).Conclusion Rational implement of opioid for analgesia in patients with moderate and severecancer pain can effectively relieve pain condition,enhance physical activity ability and improve quality of life.