盐酸氢吗啡酮皮下滴定用于癌痛镇痛的临床分析

Clinical Analysis of Subcutaneous Titration of Hydromorphone Hydrochloride for Analgesia of Cancer Pain

目的评价盐酸氢吗啡酮皮下滴定给药用于中重度癌痛镇痛的使用剂量、缓解疼痛结果及不良反应的发生情况。方法选取2021年9月—2022年8月莆田学院附属医院疼痛科的中重度癌痛患者60例,随机分为A、B两组,A组30例通过盐酸氢吗啡酮皮下给药滴定,B组30例口服盐酸吗啡片滴定,比较两组3天之内的药物剂量、治疗前后NRS评分、爆发性疼痛发作次数及不良反应发生率。结果A组Day3用量低于B组,差异有统计学意义(t=5.905,P<0.001)。A组Day3的NRS评分为(0.76±0.19)分,低于B组的(1.78±0.14)分,差异有统计学意义(t=-23.951,P<0.001)。A组Day3无发生爆发性疼痛患者占90.0%,高于B组的46.7%,差异有统计学意义(P<0.001)。治疗后,A组便秘发生率(13.3%)低于B组(36.7%),差异有统计学意义(χ^(2)=4.356,P<0.05),两组均未发生呼吸抑制。结论盐酸氢吗啡酮皮下给药滴定用于癌痛患者的药物使用剂量低、疼痛缓解率高,可显著减少爆发性疼痛发作次数,值得临床推广。

Objective To evaluate the analgesic dose,pain relief results and adverse reactions of hydromorphone hydrochloride for moderate and severe cancer pain by subcutaneous titration.Methods Sixty patients with moderate to severe cancer pain from the Department of Pain of Putian University Affiliated Hospital from September 2021 to August 2022 were randomly divided into group A and group B.In group A,thirty cases were titrated by subcutaneous administration of hydromorphone hydrochloride,and in group B,thirty cases were titrated by oral morphine hydrochloride tablets.The drug dose,NRS score before and after treatment,the frequency of explosive pain and the incidence of adverse reactions were compared between the two groups within 3 days.Results The Day3 dosage in group A was lower than that in group B,the difference was statistically significant(t=5.905,P<0.001).After analgesic treatment,the NRS score of Day3 in group A was(0.76±0.19)points,which was lower than that in group B(1.78±0.14)points,the difference was statistically significant(t=-23.951,P<0.001).90.0%of patients with Day3 without explosive pain in group A were higher than 46.7%in group B,the difference was statistically significant(P<0.001).After treatment,the incidence of constipation in group A(13.3%)was lower than that in group B(36.7%),the difference was statistically significant(χ^(2)=4.356,P<0.05),and no respiratory depression occurred in both groups.Conclusion The subcutaneous titration of hydromorphone hydrochloride for cancer pain patients has low dose and high pain relief rate,which can significantly reduce the number of explosive pain attacks,and is worthy of clinical promotion.