胃复安预防羟考酮诱导的恶心呕吐的前瞻性观察

Prospective observation of metoclopramide in preventing nausea and vomiting induced by oxycodone

目的观察胃复安片对羟考酮缓释片在癌痛治疗中所致阿片诱导的恶心呕吐(OINV)的预防作用。方法采用前瞻性观察法,收集第1次接受羟考酮缓释片止痛治疗的恶性肿瘤患者120例。根据NRS评分,将患者分为中度疼痛(4~6分)和重度疼痛(7~10分)两组。分别首先给予起始剂量10 mg、20 mg q12 h的羟考酮缓释片止痛治疗,再根据疼痛控制情况进行滴定。采用随机数表法分为观察组60例,对照组60例。观察组在口服羟考酮缓释片的同时给予胃复安片10 mg tid进行预防治疗,OINV达到Ⅱ度时加用昂丹司琼片8 mg止吐治疗。对照组不预防止吐治疗,直到OINV达到Ⅱ度,加用胃复安片10 mg tid止吐治疗,症状不缓解时给予昂丹司琼片8 mg强化治疗。观察期为14 d,比较两组患者OINV、便秘、尿潴留、嗜睡、呼吸抑制等不良反应的发生率、QOL评分、NRS评分之间的差异。结果观察组第1、2、3、7天OINV发生率明显低于对照组(P<0.05)。两组昂丹司琼使用率无明显差异(10.0%vs 15.0%)。观察组便秘发生率明显低于对照组(45.0%vs 65.0%)(P<0.05)。观察组和对照组第14天NRS评分无明显差异。观察组第1、2、3、14天QOL评分明显高于对照组(P<0.05)。两组其余不良反应发生率无明显差异。结论癌痛治疗中预防性应用胃复安片能有效减少OINV早期发生率,降低便秘发生率;同时不会对羟考酮缓释片的止痛效果造成影响,也不会产生其他不良反应,能够有效提升患者的生活质量。

Objective To observe the preventive effect of metoclopramide tablets on opioid-induced nausea and vomiting(OINV)caused by oxycodone sustained-release tablets during the treatment of cancer pain.Methods The method of prospective observation was used by collecting 120 patients with malignant tumors who were treated with oxycodone sustained-release tablets for the first time.According to the NRS scores,the patients were divided into two groups:moderate pain(4-6 points)and severe pain(7-10 points).The patients were treated with oxycodone sustained-release tablets with an initial dose of 10 mg and 20 mg q12 h respectively,and then titrated according to the pain control.The patients were divided into observation group(n=60)and control group(n=60)by using themethod of random number table.The observation group received oral oxycodone sustained release tablets and metoclopramide tablets of 10 mg tid for preventive treatment,and ondansetron tablets of 8 mg antiemetics when OINV reaching degreeⅡ.The control group did not receive preventive antiemetic treatment until OINV reached gradeⅡwhen metoclopramide tablet of 10 mg tid for antiemetic treatment was added.If the symptoms did not relieve,ondansetron tablets of 8 mg for intensive treatment would be added.The differences between the incidence of adverse reactions such as OINV,constipation,urinary retention,drowsiness,respiratory depression,QOL score,and NRS score were compared between the two groups after the observation period of 14 days.Results The incidence of OINV of the observation group was significantly lower than that of the control group(P<0.05)on days 1,2,3,and 7.There was no significant difference in the prescription frequence of ondansetron between the two groups(10.0%vs 15.0%).The incidence of constipation in the observation group was significantly lower than in the control group(45.0%vs 65.0%)(P<0.05).There was no significant difference in NRS scores on day 14 between the observation group and the control group.The QOL scores of the observation group were significantly higher than those of the control group(P<0.05)on days 1,2,3,and 14.There was no significant difference in the incidence of other adverse events between the two groups.Conclusions The preventive application of metoclopramide tablets in the treatment of cancer pain can effectively reduce the early incidence of OINV and the constipation without affecting the analgesic effect of oxycodone sustained-release tablets or producing other adverse events which can effectively improve the life quality of the patients.