盐酸美沙酮片维持治疗难治性癌性疼痛的疗效

Methadone Hydrochloride Tablets Maintain the Therapeutic Effect of Refractory Cancer Pain

目的观察盐酸美沙酮片维持治疗难治性癌性疼痛的临床疗效。方法选取2018年5月~2019年5月我院诊治的70例难治性癌性疼痛患者为研究对象,给予吗啡即释片镇痛转换为口服盐酸美沙酮片治疗,观察治疗后疼痛的总缓解率、不同疼痛性质镇痛效果、治疗前后KPS评分、疼痛强度(PI)评分、爆发痛情况、日吗啡即释片与盐酸美沙酮片使用剂量及不良反应(恶心、呕吐、腹胀、疲乏、头晕、便秘、发热、尿频)发生情况。结果治疗后疼痛的总缓解率为85.71%、骨转移痛有效率86.67%(26/30)、肿瘤侵犯或压迫神经痛有效率85.71%(24/28)、内脏痛有效率83.33%(10/12);治疗后KPS评分高于治疗前,疼痛强度(PI)评分低于治疗前,差异有统计学意义(P<0.05);盐酸美沙酮稳态后1~3次爆发痛次数发生率高于吗啡即释片滴定稳态后次数,3次以上爆发痛次数低于吗啡即释片滴定稳态后次数,差异有统计学意义(P<0.05);第2周日盐酸美沙酮片使用剂量低于稳态日吗啡即释片剂量,差异有统计学意义(P<0.05);不良反应均较轻微,对症治疗或用药时间延长后,大部分不良反应得到缓解。结论盐酸美沙酮片对于难治性癌性疼痛的效果确切,日使用剂量低于吗啡,且不良反应发生率轻微,应用安全可靠,值得临床应用。

Objective To observe the clinical efficacy of methadone hydrochloride tablets for maintenance treatment of refractory cancer pain.Methods A total of 70 patients with refractory cancer pain diagnosed and treated in our hospital from May 2018 to May 2019 were selected as study subjects.Give morphine immediate release tablets for analgesia and switch to oral methadone hydrochloride tablets,observe the total remission rate of pain after treatment,the analgesic effect of different pain properties,KPS score before and after treatment,pain intensity(PI)score,burst pain,the dosage and adverse reactions of morphine immediate release tablets and methadone hydrochloride tablets(nausea,vomiting,Abdominal distension,fatigue,dizziness,constipation,fever,frequent urination).Results The total remission rate of pain after treatment is 85.71%,the effective rate of bone metastasis pain is 86.67%(26/30),the effective rate of tumor invasion or compression neuralgia is 85.71%(24/28),and the effective rate of visceral pain is 83.33%(10/12);KPS score after treatment is higher than before treatment,and the pain intensity(PI)score is lower than before treatment,the difference was statistically significant(P<0.05);methadone hydrochloride has a high incidence of 1 to 3 burst pain after steady state the number of morphine immediate release tablets after titration at steady state,the number of pains more than 3 times after titration of morphine immediate release tablets after titration at steady state,the difference was statistically significant(P<0.05);the second week,the daily dose of methadone hydrochloride tablets Below the steady-state daily morphine dose,the difference was statistically significant(P<0.05);adverse reactions were mild,and most of the adverse reactions were relieved after prolonged symptomatic treatment or medication.Conclusion Methadone hydrochloride tablets have a definite effect on refractory cancer pain.The daily dose is lower than morphine,and the incidence of adverse reactions is slight.The application is safe and reliable,and it is worthy of clinical application.