社区卫生服务中心舒缓疗护病房肿瘤患者癌痛治疗情况及镇痛效果影响因素分析

Pain management for cancer patients in hospice wards of community health centers

目的了解社区卫生服务中心舒缓疗护病房收治的肿瘤患者癌痛管理情况及其影响因素。方法回顾性纳入2015年1月至2021年7月上海市徐汇区康健社区卫生服务中心和金山区金山卫镇社区卫生服务中心舒缓疗护病房收治的肿瘤患者的临床资料,分析肿瘤患者癌痛情况、镇痛药物使用情况、镇痛治疗效果及其影响因素。结果收治373例肿瘤患者的癌痛发生率为93.0%(347/373),中重度癌痛合计占比达55.6%(193/347)。304例使用了镇痛药物,其中233例(76.6%)患者口服镇痛药物,297例(97.7%)患者按时使用,97.6%(285/292)使用了缓释剂型阿片类药物,94例(30.9%)联合用药。100例(32.9%)发生爆发痛,均使用速释吗啡控制爆发痛。172例(56.58%)的癌痛患者疼痛得到缓解,多因素logistic回归分析显示入院时疼痛程度(中度:OR=3.69,95%CI:2.09~6.49;重度:OR=5.52,95%CI:2.43~12.53)、有无爆发痛(OR=3.28,95%CI:1.77~6.06)、使用镇痛药物种类(非甾体类+弱阿片类:OR=0.39,95%CI:0.20~0.76;非甾体类+强阿片类:OR=0.20,95%CI:0.08~0.51)及有无不良反应(OR=1.92,95%CI:1.03~3.60)是影响癌痛患者疼痛缓解的因素(均P<0.05)。结论社区舒缓疗护病房收治的肿瘤患者中癌痛情况不容忽视,虽然大部分癌痛患者规范使用了镇痛药物,但仍有较高比例患者疼痛尚未得到控制;多种因素影响镇痛治疗效果。

Objective To investigate the status quo of pain management for cancer patients in hospice care wards of community health service centers.Methods The electronic medical records of 373 cancer patients admitted in hospice wards of Kangjian Community Health Center of Xuhui District and Jinshanwei Town Community Health Center of Jinshan District from January 2015 to July 2021 were collected.The characteristics of cancer pain,the use of analgesic drugs,the effects of analgesic drugs and its influencing factors were analyzed.Results The incidence of cancer pain in 373 patients was 93.0%(347/373),and the proportion of moderate to severe cancer pain was 55.6%(193/347).Analgesics were used in 304 patients,among whom 233(76.6%)patients used oral analgesics,297(97.7%)used on time,97.6%(285/292)used sustained-release opioids,and 94(30.9%)used combinedly.Breakout pain occurred in 100 cases(32.9%),all of which was controlled with immediate-release morphine.Cancer pain was not relieved in 132 cases(43.42%),and multivariate logistic regression analysis showed that the pain degree on admission(moderate:OR=3.69,95%CI:2.09-6.49;severe:OR=5.52,95%CI:2.43-12.53),the presence of burst pain(OR=3.28,95%CI:1.77-6.06),the type of analgesics used(non-steroidal+weak opioids:OR=0.39,95%CI:0.20-0.76;nonsteroidal+strong opioids:OR=0.20,95%CI:0.08-0.51)and the adverse reactions(OR=1.92,95%CI:1.03-3.60)were the influencing factors of pain relief in cancer pain patients(all P<0.05).Conclusion The pain of cancer patients admitted to community palliative care wards cannot be ignored.Although most cancer pain patients use analgesic drugs in a standard way,there are still a high proportion of patients whose pain is not controlled.Various factors affect the effect of analgesic treatment.