终末期癌痛患者镇痛药物使用情况及特殊人群用药分析

Analysis of analgesic drug use in patients with end-stage cancer pain and drug use in special population

目的:分析终末期癌痛患者镇痛药物使用及特殊人群用药情况。方法:分析苏州大学附属太仓一院2021年1月—2022年6月103例终末期癌痛患者镇痛药物及特殊人群用药方案。结果:终末期癌痛患者镇痛以传统治疗方案为主,联合用药60例(58.25%)。爆发痛患者50例(48.54%),爆发痛患者阿片类药物剂量显著高于无爆发痛患者,差异有统计学意义(P<0.001),肾功能不全患者不同阿片类药物的用药剂量比较,差异有统计学意义(P<0.05),其他骨痛及肝不全等特殊人群不同阿片类药物的用药剂量比较,差异无统计学意义(P>0.05)。药物使用不合理性主要体现在遴选的药品不适宜占1.94%,用法用量不适宜占6.8%,其他不适宜情况占3.88%。肝功能不全患者占比33.98%,终末期阿片类药物剂量较前显著增加(P<0.001),肾功能不全患者占比57.28%,终末期阿片类药物剂量较前显著增加(P<0.001)。终末期不良反应的发生主要集中在呼吸抑制及便秘,呼吸抑制发生率4.85%,便秘的发生率29.13%。结论:终末期癌痛患者镇痛方案仍局限在传统的口服及外用贴剂等镇痛方式,仍需关注用药合理性,尤其是肝肾功能不全患者,药物使用可能导致不良反应的发生。

Objective To analyze the use of analgesic drugs in patients with end-stage cancer pain and drug use in special population.Methods 103 patients with end-stage cancer pain in our hospital from January 2021 to June 2022 were collected,and the use of analgesic drugs in patients and drugs in special population was retrospectively analyzed.Results Analgesia for patients with end-stage cancer pain was mainly based on traditional treatment,60 patients(58.25%)had combined medication.50 patients(48.54%)had burst pain,the opioid dose in patients with flare-up pain was significantly higher than that in patients without flare-up pain(P<0.001).There was statistical difference in the dosage of opiates in patients with renal insufficiency(P<0.05),but no statistical difference in the dosage of opiates in other special groups such as bone pain and liver insufficiency(P>0.05).The irrationality of drug use was mainly reflected in three aspects,Unsuitable drugs accounted for 1.94%,unsuitable usage and dosage accounted for 6.8%,and other unsuitable conditions accounted for 3.88%.The proportion of patients with liver insufficiency was 33.98%,compared with earlier stage,the dose of end-stage opioid was significantly increased(P<0.001).The proportion of patients with renal insufficiency was 57.28%,and the dose of end-stage opioid was significantly increased(P<0.001).The occurrence of adverse reactions mainly concentrated in respiratory depression and constipation,the incidence rates were 4.85%and 29.13%respectively.Conclusion Analgesic programs for patients with end-stage cancer pain are still limited to traditional oral and topical patch analgesic methods,and rational use of drugs should be paid attention to,especially for patients with liver and kidney dysfunction,because drug use may lead to adverse reactions.