Multicenter Clinical Study for Evaluation of Efficacy and Safety of Transdermal Fentanyl Matrix Patch in Treatment of Moderate to Severe Cancer Pain in 474 Chinese Cancer Patients

Objective: Although a new matrix formulation fentanyl has been used throughout the world for cancer pain management, few data about its efficacy and clinical outcomes associated with its use in Chinese patients have been obtained. This study aimed to assess the efficacy and safety of the new system in Chinese patients with moderate to severe cancer pain. Methods: A total of 474 patients with moderate to severe cancer pain were enrolled in this study and were treated with the new transdermal fentanyl matrix patch (TDF) up to 2 weeks. All the patients were asked to record pain intensity, side effects, quality of life (QOL), adherence and global satisfaction. The initial dose of fentanyl was 25 ?g/h titrated with opioid or according to National Comprehensive Cancer Network (NCCN) guidelines. Transdermal fentanyl was changed every three days. Results: After 2 weeks. The mean pain intensity of the 459 evaluated patients decreased significantly from 5.63?1.26 to 2.03?1.46 (P<0.0001). The total remission rate was 91.29%, of which moderate remission rate 53.16%, obvious remission rate 25.49% and complete remission rate 12.64%. The rate of adverse events was 33.75%, 18.78% of which were moderate and 3.80% were severe. The most frequent adverse events were constipation and nausea. No fatal events were observed. The quality of life was remarkably improved after the treatment (P<0.0001). Conclusion: The new TDF is effective and safe in treating patients with moderate to severe cancer pain, and can significantly improve the quality of life.

Conversing Rate from Morphine to Continuous Infusion of Fentanyl in Patients Suffering Cancer Pain

Objective： To investigate the proper conversing rate from morphine to continuous infusion of fentanyl in patients suffering cancer pain. Methods： A retrospective study was carried on in 20 patients with cancer pain in Shizuoka Cancer Center from Sep. 2002 to Nov. 2003. Pain intensity, adverse reactions, and satisfaction index of patients were evaluated. Results： The pain intensity was stable in 17 patients indicating good pain-control within 1 week after conversion and unstable in 3 patients after conversion suggesting poor pain-control. Fentanyl injection could alleviate side effects and increase the satisfaction index of patients. Conclusion： The equipotent ratio for conversion of low dose morphine to fentanyl injection was established as 72：1, and for non low dose morphine a ratio less than 72：1 was proposed to get stable pain-relieving effect. But the equipotent ratio for conversion of morphine to continuous infusion of fentanyl could not be determined. We must consider the morphine dose before the confirmation of the conversing rate.

Application of fentanyl transcutaneous strap in treatment of cancerous pain

Fentanyl transcutaneous strap is a kind of long termed opoid drug for treatment of moderate and severe pain.Its commercial name is Duoridge.It exchanges once every 72 hours.It can directly jump from step I to step III in clinic use.It is a safe and effective choice for those dying cancerous patients,and is practicable in child cancerous pain.It has no significant difference in pain relieving compared to morphine.It has less lethargy effect of day time than morphine but causes good sleep at night.Adverse effects of Duoridge are less than morphine administrated per os.

Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study

AIM To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.METHODS This was a 3-mo prospective observational study(n = 207).Patients were included if they were adults(≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around the clock pain medication for cancer or cancer-treatment-related pain.Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia.A choice-based conjoint(CBC) analysis experiment was used to elicit analgesic treatment preferences(utilities).Patients employed trade-offs based on five analgesic attributes(percent relief from analgesics, type of analgesic, type of sideeffects, severity of side-effects, out of pocket cost).Patients were clustered based on CBC utilities using novel adaptive statistical methods.Multiple logistic regression was used to identify predictors of cluster membership.RESULTS The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief(cluster 1, 41%).For a subset, the main underlying concern was type of analgesic prescribed, i.e., opioid vs non-opioid(cluster 2, 11%) and type of analgesic side effects(cluster 4, 21%), respectively.About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects(cluster 3, 27.5%).In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors(education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief, i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1(-); cluster 4(+)].CONCLUSION Most patients appear to be driven by a single salient concern in using analgesia for cancer pain.Addressing these concerns, perhaps through real time clinical assessments, may improve patients' analgesic adherence patterns and cancer pain outcomes.

Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury

BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries(ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous(IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.METHODS: In this double-blind randomized clinical trial, 320 patients with ATLI, who presented to the emergency department(ED) from February 2016 to April 2016, were randomly divided into two groups. One group(160 patients) received 0.1 mg/kg IV morphine. The other group(160 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specif ic intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up(P value=0.00). However, at 10, 30, and 60-minute follow-ups no signifi cant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12(7.7%) patients in the fentanyl group and in 48(31.6%) patients in the morphine group(P value=0.00). No signifi cant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.CONCLUSION: Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Impact of adding opioids to paravertebral blocks in breast cancer surgery patients:A systematic review and meta-analysis

BACKGROUND Several breast cancer studies have reported the use of adjuvant opioids with the paravertebral block(PVB)to improve outcomes.However,there is no level-1 evidence justifying its use.AIM To elucidate if the addition of opioids to PVB improves pain control in breast cancer surgery patients.METHODS We conducted an electronic literature search across PubMed,Embase,Scopus,and Google Scholar databases up to October 20,2020.Only randomized controlled trials(RCTs)comparing the addition of opioids to PVB with placebo for breast cancer surgery patients were included.RESULTS Six RCTs were included.Our meta-analysis indicated significantly reduced 24-h total analgesic consumption with the addition of opioids to PVB as compared to placebo[standardized mean difference(SMD)-1.57,95%confidence interval(CI):-2.93,-0.21,I2=94%].However,on subgroup analysis,the results were nonsignificant for studies using single PVB(SMD:-1.76,95%CI:-3.65,0.13 I2=95.09%)and studies using PVB infusion(SMD:-1.30,95%CI:-4.26,1.65,I2=95.49%).Analysis of single PVB studies indicated no significant difference in the time to first analgesic request between opioid and placebo groups(mean difference-11.28,95%CI:-42.00,19.43,I2=99.39%).Pain scores at 24 h were marginally lower in the opioid group(mean difference-1.10,95%CI:-2.20,0.00,I2=0%).There was no difference in the incidence of postoperative nausea and vomiting between the two groups.CONCLUSION Current evidence suggests a limited role of adjuvant opioids with PVB for breast cancer surgery patients.Further homogenous RCTs with a large sample size are needed to clarify the beneficial role of opioids with PVB.

Effectiveness and safety of acupuncture on cancer pain: a meta-analysis

Objective:The aim of the study was to evaluate the efficacy of acupuncture combined with opiates in the treatment of cancer pain through the meta-analysis system.Methods:China national knowledge infrastructure and VIP Database for Chinese technical periodicals,China Biology Medicine,PubMed,Embase databases were searched from January 2016 to February 8,2020 for the randomized controlled trials on the effects of acupuncture combined with opiates on cancer pain.Meta-analysis of ordered data was performed using Stata-MP64 and Review Manager 5.3 software.Results:A total of 242 Chinese studies and 25 English studies were retrieved.According to the inclusion and exclusion criteria,19 literatures finally were included.The fixed effect model was used to combine the total effect values,and the combined odds ratio(OR)(95%confidence interval(CI))was 2.981(2.384,3.729),suggesting that acupuncture combined with opiates was better than opiates alone in treating cancer pain(Z=9.57,P<0.05);the combination treatment could improve Karnofsky Performance Status score(Z=2.48,P=0.01),decrease Numerical Rating Scale score(Z=2.89,P=0.004);it also could reduce eruption pain frequency(Z=4.32,P<0.0001),improve the effects time(Z=2.51,P=0.01),and extend analgesia duration(Z=4.33,P<0.0001);the combination group also had lower Oxycodone dose than the control group(Z=3.193,P=0.001).At the same time,the incidence of adverse reactions was lower than that of the opiate treatment group alone,with a OR(95%CI)of 0.27(0.19,0.37)and statistical significance,Z=8.06,P<0.05.Conclusion:Acupuncture combined with opioids for cancer pain is superior to opioids alone with a lower incidence of adverse reactions.

三焦灸技术在癌痛患者阿片类药物相关性便秘中的应用研究

[目的]探讨应用三焦灸技术治疗阿片类药物相关性便秘的效果。[方法]选取2022年7月—2023年6月天津中医药大学第一附属医院肿瘤科中晚期肿瘤患者服用阿片类药物相关性便秘的患者60例,运用随机法将患者分为对照组30例和观察组30例。对照组采用肿瘤科常规护理,观察组在对照组的基础上行三焦灸技术改善其便秘症状。[结果]两组患者治疗前在性别、年龄、医疗诊断方面,差异均无统计学意义(P>0.05),具有可比性。治疗2周后两组患者相比较,便秘严重程度评分中除病程外,均具有统计学意义(P<0.05);观察组在便秘的生存质量和治疗总有效率改善情况相较于对照组更为明显(P<0.05)。[结论]三焦灸技术可有效改善癌痛患者阿片类药物相关性便秘的症状,提高患者生活质量,值得进一步推广。

联合应用多种中医适宜技术干预阿片类药物相关性便秘的多中心临床研究

目的通过多中心临床研究,评价多项中医适宜技术联合干预对阿片类药物相关性便秘的临床疗效。方法2021年7月至2022年10月,在上海中医药大学附属岳阳中西医结合医院肿瘤科病房、利群医院安宁疗护病房、长征社区卫生服务中心安宁疗护病房选取符合阿片类药物相关性便秘诊断标准及便秘津亏肠燥证辨证标准的住院患者为研究对象,采用随机数字法分为对照组(n=164)与观察组(n=164)。两组患者均参照《阿片类药物相关性便秘中西医结合护理方案》开展常规护理工作。对照组在常规护理的基础上,给予乳果糖口服液(每日3次,每次10 mL空腹服用)及相应的用药指导;观察组在常规护理的基础上,采用中药贴敷、中药离子导入、耳穴压豆3项中医适宜技术联合干预。两组患者干预时间均为14 d,比较两组患者干预后的日均排便次数、平均排便间隔时间,干预前后的便秘症状、便秘相关生活质量及疼痛评分。结果观察组患者治疗便秘的显效率(31.71%)高于对照组(8.54%),且两组便秘症状疗效比较,差异有统计学意义(Z=-5.41,P<0.01);治疗后两组患者的日均排便次数及平均排便间隔时间差异均无统计学意义(P>0.05);两组患者治疗后便秘症状及相关生活质量较治疗前均有明显改善和提高,且观察组便秘症状及便秘相关生活质量评分的变化均比对照组更为明显,差异均有统计学意义(P<0.01);两组患者干预后疼痛评分均明显低于干预前,差异有统计学意义(P<0.01),但组间差异无统计学意义(P>0.05)。结论多种中医适宜技术联合干预可改善阿片类药物相关性便秘患者的便秘情况,同时可有效缓解患者的便秘不适症状、提高患者的生活质量,符合晚期肿瘤患者安宁疗护的理念,具有一定临床推广意义。

闭环式管理模式对门诊癌痛患者的护理效果评价

目的探索闭环式管理模式对门诊癌痛患者的镇痛效果及可行性。方法收集2019年12月—2020年6月在江苏省肿瘤医院镇痛门诊首诊并使用阿片类药物(羟考酮缓释片)进行镇痛治疗的癌痛患者112例为研究对象。按照组间基本特征具有可比性的原则将患者分为对照组和观察组,每组56例,对照组给予常规管理;观察组接受闭环式管理模式,包括对患者首诊、复诊、定期随访、宣教、用药记录、指导等,同期疼痛门诊专科医师、药师、护士对患者制订个体化规范、合理、有效的镇痛方案及随诊计划,重点解决患者镇痛用药依从性,随诊反馈中存在的问题。两组患者均接受持续1个月的管理,记录并比较两组患者管理前后的服药依从率、数字评分量表(NRS)、爆发痛次数、疼痛控制满意程度,外周血β-内啡肽(β-EP)、前列腺素E-2(PGE-2)、内皮素-1(ET-1)、体质状况(KPS)评分,记录两组患者管理后对护理满意程度及管理期间发生的不良反应。结果管理前,两组患者的服药依从率、NRS、爆发痛次数、β-EP、PGE-2、ET-1、KPS评分比较差异均无统计学意义(P>0.05);管理后,观察组患者的服药依从率、镇痛满意程度、β-EP、护理满意程度和KPS评分高于对照组,差异均有统计学意义(P<0.05)。观察组患者的NRS、PGE-2、ET-1和不良反应发生程度均低于对照组,爆发痛次数少于对照组,差异均有统计学意义(P<0.05)。结论闭环式管理模式可有效提升门诊癌痛患者服药依从,有效控制疼痛,改善患者体质。

枳实消痞方联合大黄神阙穴贴敷治疗阿片类药物相关性便秘临床观察

目的探讨枳实消痞方联合大黄神阙穴贴敷治疗阿片类药物相关性便秘(OIC)的临床疗效。方法选取医院中西医结合科2021年1月至2022年1月收治的口服盐酸羟考酮缓释片治疗癌性疼痛的OIC患者70例,按随机数字表法分为观察组和对照组,各35例。观察组患者予枳实消痞方联合大黄粉神阙穴贴敷治疗,对照组患者予乳果糖口服溶液治疗,均连续用药2周。结果观察组患者的便秘治疗总有效率为85.71%,显著高于对照组的57.14%(P<0.05)。观察组患者治疗后的慢性便秘严重程度评分量表及便秘患者生活质量量表各项评分和总分均显著低于对照组(P<0.05);观察组患者的卡氏体力状况量表(KPS)评分有效率为82.86%,显著高于对照组的60.00%(P<0.05)。结论枳实消痞方联合大黄神阙穴贴敷能缓解OIC症状,改善患者的生活质量,增强其体力。

中医外治法治疗阿片类药物相关性便秘的网状Meta分析

【目的】探讨网状Meta分析不同中医外治法治疗阿片类药物相关性便秘的疗效。【方法】计算机检索中国知网、万方、中国生物医学文献数据库、维普、PubMed、Embase、Web of Science和The Cochrane Library数据库中关于中医外治法治疗肿瘤患者阿片类药物相关性便秘的文献,检索时限均为建库至2023年3月20日。同时,追溯相关系统评价和纳入研究的参考文献。由两名研究者独立筛选文献和提取资料,评估文献质量。采用RevMan 5.3软件、Stata 17.0软件和R 4.2.3软件中的Gemtc程序包进行统计学分析。【结果】纳入17篇文献,共1570例患者,涉及7种干预措施。网状Meta分析结果显示,穴位贴敷+常规治疗(OR=7.00,95%CI=3.90~13.00,P<0.05)、艾灸+常规治疗(OR=6.20,95%CI=2.20~21.00,P<0.05)、腹部推拿+常规治疗(OR=8.80,95%CI=2.40~46.00,P<0.05)的疗效优于常规治疗,SUCRA值显示,疗效排名前三的中医外治法依次为腹部推拿+常规治疗(80.36%)、穴位贴敷+常规治疗(74.54%)、艾灸+常规治疗(68.76%)。【结论】推荐采用腹部推拿+常规治疗措施缓解阿片类药物相关性便秘,但在实际临床工作中,应考虑患者意愿、患者身体情况等多方面因素进行决策。

龙藤通络方联合阿片类止痛药治疗中重度肺癌癌痛的前瞻性临床研究

目的观察龙藤通络方外用联合阿片类止痛药治疗中重度肺癌癌痛的临床疗效。方法采用多中心、开放标签的随机对照试验设计,收集中重度肺癌癌痛患者117例(治疗组57例,对照组60例),治疗组采用阿片类药物联合龙藤通络方外用,对照组采用单纯阿片类药物,连续给药8天,分别观察两组患者疼痛治疗前后数字疼痛评分法(numerical rating scale,NRS)评分、日均吗啡消耗量、爆发痛次数、止痛起效时间及不良反应,评价镇痛疗效。并运用UPLC-QQQ-MS/MS质谱技术对龙藤通络方含测指标进行检测,预估止痛有效成分。结果治疗组疼痛缓解率97.37%,显效率为50.88%,均高于对照组(P<0.05),治疗组治疗前后NRS评分差值为(2.07±1.02)分,与对照组比较差异有统计学意义(P<0.05)。分层分析显示在不同疼痛程度及类型人群中,龙藤通络方联合阿片类药物对中度疼痛(NRS评分4分~7分)、骨转移性癌痛以及副肿瘤综合征、恶病质等引起的癌痛人群中治疗疗效更有优势,治疗前后NRS差值与同类型对照组有明显差异(P<0.05)。治疗组中度疼痛亚组患者的等效吗啡日均消耗量为(61.57±51.69)mg,少于中度疼痛对照组(P<0.05)。龙藤通络方联合治疗后与外治相关的不良反应以皮肤瘙痒和局部红肿为主,其余发生率超过10%的不良反应主要为恶心呕吐、便秘、头晕、肝肾功能及心电图异常。质谱分析检测出龙藤通络方中野漆树苷、络石苷等7个活性指标性化合物,这些有效成分可能在肺癌癌痛治疗中起着一定作用。结论龙藤通络方联合阿片类止痛方案有协同、增效的作用,尤其在中度疼痛中效果显著,可减少中度疼痛患者阿片类药物日均消耗量,且安全性好。

羟考酮联用抗抑郁药治疗癌性疼痛:有效性和安全性的Meta分析

目的系统评价羟考酮联合抗抑郁药物治疗癌性疼痛的有效性和安全性。方法计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library等数据库,收集有关羟考酮联合抗抑郁药物治疗癌性疼痛的随机对照试验研究,检索时间均限定为建库至2023年7月。由2名研究人员根据纳入与排除标准进行独立的文献筛选、资料提取及质量评价。运用RevMan 5.4进行数据合并与分析。结果最终纳入18项研究,共1399例癌痛患者。Meta分析结果显示,对比单药治疗,羟考酮联合抗抑郁药物治疗癌性疼痛在临床治疗总有效率[RR=1.28,95%CI(1.17,1.41),P<0.001]、疼痛程度评分[MD=-0.92,95%CI(-1.10,-0.74),P<0.001]、羟考酮日均用量[MD=-15.64,95%CI(-23.91,-7.37),P<0.001]、爆发性痛发生次数[MD=-0.60,95%CI(-0.68,-0.52),P<0.001]、抑郁[SMD=-2.99,95%CI(-3.91,-2.07),P<0.001]、焦虑评分[SMD=-2.26,95%CI(-3.42,-1.10),P<0.001]方面更具优势。在不良反应发生方面,羟考酮联用抗抑郁药物能显著减少便秘的发生率[RR=0.81,95%CI(0.70,0.93),P<0.001],且不增加恶心呕吐、头晕嗜睡、排尿障碍、皮肤瘙痒、食欲不振的发生率,差异无统计学意义(P>0.05)。羟考酮联合抗抑郁药物可能增加口干的发生风险[RR=2.30,95%CI(1.19,4.45),P=0.01],但该项Meta分析结果敏感性较高,缺乏稳健性。按抗抑郁药物类别进行亚组分析,结果与上述Meta分析结果一致。结论当前证据表明,羟考酮联合抗抑郁药物治疗癌痛的临床疗效较好,安全性较高。但由于其可能增加口干的风险,临床运用时在临床应用中应权衡利弊,使癌症患者获得更优的镇痛方案。因所纳文献的数量与质量的局限性,上述结论有待进一步验证。

全身阿片类药物转换为鞘内吗啡时戒断反应的临床研究

目的:观察全身阿片类药物转换为鞘内吗啡镇痛时的戒断反应,探讨病人静脉自控给药治疗的可行性。方法:选取2022年11月至2023年9月就诊于东部战区总医院的阿片类药物耐受的难治性癌痛病人30例,经吗啡静脉病人自控镇痛(patient controlled analgesia,PCA)剂量滴定24 h后植入半植入式鞘内药物输注系统,外接PCA泵鞘内持续输注吗啡。采用临床阿片类药物戒断量表(clinical opiate withdrawal scale,COWS)评估静脉吗啡转换为鞘内吗啡期间病人阿片戒断反应(opioid withdrawal reaction,OWR),记录OWR的发生次数、时间和程度;根据COWS评分将病人分为无OWR组(n=7)和OWR组(n=23),依据OWR的程度分为轻(n=4)、中(n=17)、中重(n=2)和重度(n=0)四组。OWR病人根据需求,采用吗啡静脉PCA给药治疗。评估转换过程中病人疼痛强度、焦虑、抑郁、睡眠、病人满意度,以及阿片类药物不良反应等。结果:本研究中OWR发生率为76.7%(23/30),轻度及中度占91.3%(21/23),其中87.0%(20/23)的病人需要通过静脉吗啡PCA缓解OWR。中重度组的COWS平均评分高于轻度组(P<0.05),中度组的PCA给药次数高于轻度组(P<0.05)。OWR组(n=23)入院时每日口服吗啡毫克当量与OWR持续时间(r=0.490,P=0.018)、发生次数(r=0.488,P=0.018)和PCA给药次数(r=0.495,P=0.016)呈正相关。病人转换为鞘内吗啡镇痛后疼痛数字分级评分法(numerical rating scale,NRS)评分、每日吗啡使用剂量均较入院时下降(P<0.05),焦虑、抑郁、睡眠均得到不同程度改善。出院时便秘发生率较术前明显降低(P<0.01)。结论:全身阿片类药物转换为鞘内吗啡镇痛时戒断反应的发生率较高,静脉吗啡PCA治疗方便易行、效果确切。

佤族和汉族癌痛患者阿片类药物需求量的比较:一项单中心回顾性研究

目的:探讨佤族和汉族癌痛患者阿片类药物需求量是否存在差异。方法:回顾性收集2020年1月~2022年12月在某院就诊的佤族和汉族癌痛患者病例,将汉族癌痛患者纳入对照组(n=232),佤族癌痛患者纳入观察组(n=30),统计并分析两组患者一般资料及阿片类药物需求量。结果:两组患者癌痛程度均为中重度,年龄、性别、体重指数、TNM分期、初始数字疼痛分级法(NRS)评分、肿瘤类型、辅助用药和阿片类药物治疗史等一般资料比较均无统计学差异(P>0.05)。观察组24h-阿片类药物需求量、体重-24h-阿片类药物需求量均少于对照组(P<0.05),两组体重-体表面积-24h-阿片类药物需求量比较无统计学差异(P>0.05),但观察组少于对照组。结论:佤族与汉族癌痛患者阿片类药物需求量存在差异,表现为佤族患者阿片类药物需求量少于汉族患者。

阿片类药物联合眼针疗法对癌性疼痛临床观察

目的 研究阿片类药物联合眼针疗法对癌性疼痛患者数字分级法(NRS)评分、生活质量量表(QOL)评分及总有效率的影响。方法 将60例癌性疼痛患者随机分成针药并用组和单纯西药组,各30例。单纯西药组遵医嘱服用盐酸羟考酮缓释片。针药并用组在此基础上联合眼针疗法,根据其脏腑、三焦、循经取穴原则选穴,配阿是穴,每日1次,治疗2周。观察2组治疗前后NRS评分、QOL评分变化情况,计算总有效率。结果 治疗2周后,2组NRS评分均下降、QOL评分均提高(P<0.01),且针药并用组NRS评分下降更为明显、QOL评分提高更为明显(P<0.01);针药并用组总有效率优于单纯西药组(P<0.05)。结论 阿片类药物联合眼针疗法可明显减轻癌痛患者的疼痛,提升生活质量水平,总有效率更高,值得推广。

Celiac plexus neurolysis in the management of unresectable pancreatic cancer:When and how?

Pancreatic cancer is the second most common abdominal cancer in North America with an estimated 20%resectability at diagnosis,and overall 5-year survival of 5%.Pain is common in pancreatic cancer patients with 70%-80%suffering substantial pain.Celiac plexus neurolysis(CPN)is a technique that can potentially improve pain control in pancreatic cancer while preventing further escalation of opioid consumption.CPN is performed by injecting absolute alcohol into the celiac plexus neural network of ganglia.This review sets out to explore the current status of CPN in non-resectable pancreatic cancer.We will examine:(1)the efficacy and safety of percutaneous-CPN and endoscopic ultrasound guided-CPN;(2)specific technique modifications including bilateral(vs central)injections and celiac ganglia neurolysis;and(3)the issue of CPN timing,early at pancreatic cancer diagnosis vs traditional late use as salvage therapy.

口服阿片类药物病人个案信息化管理模式的应用研究

目的:探讨个案信息化管理模式在口服阿片类药物病人延续护理中的应用效果。方法:通过便利抽样法选取2020年1月—2020年12月于江苏省某三级综合医院肿瘤科住院的180例癌痛病人为研究对象,随机分为试验组与对照组,每组90例。两组病人住院期间均接受个案管理,出院后对照组病人接受常规个案管理,试验组接受个案信息化管理。干预12个月后,比较两组病人阿片类药物正确执行率、爆发痛发作次数、疼痛知识得分和满意度得分。结果:干预12个月后,试验组病人阿片类药物正确执行率(82.5%)高于对照组(48.6%),比较差异有统计学意义(P<0.05);疼痛知识得分(94.38±4.93)分和满意度得分(96.88±3.76)分均高于对照组的(65.34±9.00)分、(68.99±8.44)分,比较差异有统计学意义(P<0.05);干预后6个月、干预后9个月和干预后12个月试验组病人爆发痛发作次数少于对照组,比较差异有统计学意义(P<0.05)。结论:个案信息化管理模式有利于提高病人疼痛相关知识水平,减少阿片类药物服药偏差和爆发痛发作次数,有利于提高病人满意度。

癌痛患者阿片类药物镇痛效果不佳的高危因素研究

目的分析癌性疼痛(简称癌痛)患者阿片类药物镇痛效果不佳的高危因素,为提高癌痛患者镇痛治疗效果提供指导。方法采用前瞻性队列研究方法,选取2021年5月至2022年5月北京市海淀医院收治的164例癌痛患者为研究对象,患者均采用阿片类药物进行镇痛治疗,观察患者治疗7 d时的镇痛效果并分为镇痛效果不佳组(23例)及镇痛效果良好组(141例),统计并比较患者一般资料,采用Logistic回归分析检验癌痛患者阿片类药物镇痛效果不佳的高危因素。结果164例患者经7 d阿片类药物镇痛治疗后,镇痛效果不佳23例,占14.02%(23/164);镇痛效果不佳组与镇痛效果良好组比较,患者未遵医嘱用药、未联合自控镇痛、药物不良反应占比高,贴敷给药占比低,初始NRS评分高,差异有统计学意义(P<0.05);Logistic回归分析显示,初始NRS评分过高、未遵医嘱用药、未联合自控镇痛均为癌痛患者阿片类药物镇痛效果不佳的高危因素(P<0.05)。结论癌痛患者阿片类药物镇痛效果不佳发生率较高,对初始NRS评分高,依从性差的患者,在选用阿片类药物阵痛时,临床需针对上述因素采取合理的干预措施提高镇痛效果,减轻患者痛苦。