芬太尼透皮贴剂治疗中重度癌性疼痛的临床观察

目的：观察芬太尼透皮贴剂治疗中重度癌性疼痛的疗效及不良反应。方法：对56例中重度癌痛的患者使用芬太尼透皮贴剂治疗,初治患者最初剂量中度疼痛从25μg.h^-1开始使用,重度疼痛可从25μg.h^-1开始,随着患者的反应逐步提高剂量。曾用过强阿片类药物的患者则根据患者用药情况进行剂量转换[芬太尼透皮贴剂的剂量（μg.h-1,q72.h^-1）=口服吗啡的剂量（mg.d^-1）×1/2]。用药后根据患者疼痛缓解情况剂量调整,按照25μg.h^-1剂量增加,直至疼痛缓解。用药期间严密观察药物剂量的调整、疗效、耐受性、药物依赖性、不良反应等。结果：全组患者完全缓解43例（76.8%）、部分缓解9例（16.1%）,总缓解率92.9%（52/56）。主要的不良反应是便秘,头晕、恶心、呕吐、皮肤瘙痒等,发生率很低。结论：芬太尼透皮贴剂治疗中重度癌性疼痛疗效确切,不良反应轻微,耐受性好,可作为口服强阿片类药物外的替代治疗,尤其适用于不能口服止痛药的患者。

Efficacy of Fentanyl Transdemal Patch for Moderate or Severe Cancer Pain

OBJECTIVE：To observe the efficacy and side effect of Fentanyl transdemal patch for patients with moderate or severe pain.METHODS：Fifty-six patients with moderate or severe cancer pain were treated with Fentanyl transdemal patch at an initial dosage of 25 μg·h^-1 for initial treatment patients with intermediate pain.For initial treatment patients with severe pain,the initial dosage of 25 μg·h^-1 was increased gradually based on patients＇ reaction.For the patients who had been treated with strong opioids,dose conversion should be conducted based on patients＇ medication [the dosage of Fentanyl Transdemal patch（μg·h^-1,q 72 h）= the dosage of oral morphine（mg·d^-1）×1/2].The dosage was modified based on the easement of pain,up 25 μg·h^-1 until easement of pain achieved.During medication,the dosage modification,curative efficacy,patients＇ drug tolerance,drug dependence and the other side effects were observed closely.RESULTS：The overall remission rate was 92.9%（52/56）,including 43 CR（complete remission）cases and 9 PR（partial remission）cases.The incidence of the adverse drug reactions including constipation,dizziness,nausea ＆ vomiting and itch of skin was low.CONCLUSION：Fentanyl Transdermal patch has proved efficacy,mild side effects and good drug tolerance in patients with moderate or severe cancer pain,and which can be served as a substitute for oral strong opioids and it is especially indicated for patients who can＇t take oral pain killers.