芬太尼透皮贴与吗啡控释片在癌痛治疗中的疗效对比

目的：评价芬太尼透皮贴剂在癌痛治疗中的临床应用价值。方法：比较芬太尼透皮贴与吗啡控释片在癌痛治疗中的疗效。结果：芬太尼透皮贴剂与吗啡控释片在癌痛治疗中疗效无明显差异，但不良反应相对较少。结论：芬太尼透皮贴疗效确定，相对安全，是目前癌痛治疗中较理想的药物之一。     

芬太尼透皮贴剂治疗中、重度癌痛76例临床观察

疼痛是癌症患者常见的症状,疼痛需要综合治疗,而药物治疗可以缓解80%的疼痛.芬太尼透皮贴剂以其止痛效果好、不良反应小、使用方便受到患者和医生的推崇,是控制中、重度疼痛的有效药物.我们2003年1月至2006年10月使用芬太尼透皮贴剂(多瑞吉)治疗慢性中、重度癌痛76例,取得良好效果,总结如下.     

芬太尼透皮贴剂治疗重度癌痛46例分析

目的：观察芬太尼透皮贴剂（多瑞吉）在重度癌痛的治疗效果及不良反应。方法：选择46例成年癌痛患者,疼痛视觉模拟评分（VAS）7-9分。多瑞吉从2.5 mg剂型开始,每隔3 d更换1次,用药18 d。结果：治疗前后的VAS比较有统计学差异（PP〈0.01）,常见的不良反应为头晕、恶心、嗜睡、便秘、呕吐及排尿困难。结论：多瑞吉能安全用于重度癌痛患者的治疗。且VAS评分在7-9分的癌痛患者。     

芬太尼透皮贴剂治疗癌痛效果及不良反应

WHO已将癌症疼痛与姑息治疗、病因预防、早期发现和早期诊断及根治性综合治疗列为世界范围内解决肿瘤问题的四大重点。最大限度地缓解癌症患的疼痛，从而改善和担高癌症患生活质量实属当务之急。     

芬太尼透皮贴剂对比吗啡治疗中重度癌痛的系统评价

目的系统评价芬太尼透皮贴剂对比口服吗啡治疗中重度癌痛的效果。方法计算机检索h e Cochrane Library（2014年第1期）、Pub Med、Web of Science、CNKI、VIP、CBM和Wan Fang Data数据库,纳入芬太尼透皮贴剂对比口服吗啡治疗中重度癌痛的随机对照试验（RCT）,检索时限截至2014年1月。由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取和评价纳入研究的方法学质量后,采用Rev Man 5.1.0软件进行Meta分析。结果共纳入35个RCT,3 406例患者。Meta分析结果显示,芬太尼透皮贴剂与口服吗啡镇痛效果差异无统计学意义[OR=1.00,95%CI（0.80,1.27）,P=0.99]。与口服吗啡相比,芬太尼透皮贴剂组患者的便秘、恶心呕吐、嗜睡和尿潴留的发生率明显较低（P〈0.05）,但皮肤刺激症状发生率明显增高（P〈0.05）。结论芬太尼透皮贴剂在治疗中重度癌痛方面效果与口服吗啡相当,且不良反应更少。但受纳入研究质量的限制,本研究结论尚需进一步开展更多高质量的RCT进行验证。     

芬太尼透皮贴剂治疗中重度骨转移癌痛31例疗效分析

目的：观察芬太尼透皮贴剂治疗骨转移瘤引起的中、重度癌痛的疗效和不良反应。方法：芬太尼透皮贴剂治疗中、重度骨转移癌痛患者31例,起始剂量25μg/h,每72 h更换。根据疼痛程度进行剂量调整。采用疼痛数字评估法NRS评定镇痛疗效,并观察不良反应和生活质量。结果：第15天时评定疗效,完全和明显缓解15例,中、轻度缓解12例,未缓解4例,总有效病例27例（87.1%）,平均起效时间（3.2±0.8）d。主要不良反应为便秘、恶心、嗜睡、皮肤瘙痒等,但发生率低,多为轻中度。结论：芬太尼透皮贴剂在治疗中重度骨转移癌痛中,镇痛效果满意,不良反应轻,使用方便安全,患者依从性好,可作为口服强阿片类药物的替代治疗。     

芬太尼透皮贴剂治疗癌痛效果及不良反应

:WHO已将癌症疼痛与姑息治疗、病因预防、早期发现和早期诊断及根治性综合治疗列为世界范围内解决肿瘤问题的四大重点。最大限度地缓解癌症患者的疼痛,从而改善和提高癌症患者生活质量实属当务之急。     

芬太尼缓释透皮贴剂治疗骨转移瘤疼痛50例分析

芬太尼缓释透皮贴剂是一种新型的、麻醉类镇痛药，其主要特点为药物通过皮肤吸收而发生疗效。我们于2005—01～2005—12用芬太尼缓释透皮贴剂治疗骨转移瘤疼痛（以下简称癌症疼痛）患者，止痛效果满意，现报道如下。     

芬太尼透皮贴剂治疗晚期癌痛的观察

目的观察芬太尼透皮贴剂(多瑞吉)对晚期癌痛伴有不能吞咽药物及使用吗啡出现严重反应的止痛效果及副作用。方法观察晚期肿瘤中度以上疼痛,同时不能口服给药患者使用多瑞吉的疗效及副作用。结果完全缓解(CR)29例,部分缓解(PR)17例,轻度缓解(MR)8例,总有效率100%,CR+PR为85.18%。结论多瑞吉能有效的控制晚期肿瘤中度以上疼痛。     

芬太尼透皮贴剂缓解中重度癌痛76例分析

目的观察临床中重度癌痛患者使用芬太尼透皮贴剂(多瑞吉)的镇痛效果,不良反应及生活质量改善情况。方法采用多中心开放研究,76例中重度临床癌痛患者使用芬太尼透皮贴剂治疗,记录疼痛变化,不良反应及生活质量改善情况。结果76例患者均取得中度以上缓解,其中完全缓解53例(70%),明显缓解15例(20%),中度缓解8例(11%),患者生活质量得到明显改善,毒副作用有嗜睡,头晕,恶心,呕吐,便秘等,无严重毒副作用。结论芬太尼透皮贴剂(多瑞吉)控制癌痛效果较好,能够明显改善患者生活质量,毒副作用轻微,给药方便。     

Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain

In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. This randomized double-blind controlled trial seeks to prove the utility of fentanyl as an alternate first-line analgesic for ischemic-type chest pain in the prehospital setting. Successive patients who were treated for suspected ischemic chest pain in the emergency medical services system were considered eligible. Once chest pain was confirmed, patients received oxygen, aspirin, and nitroglycerin therapy. If the ischemic-type chest pain continued the patient was randomized in a double-blinded fashion to treatment with either morphine or fentanyl. Pain scale scores, necessity for additional dosing, and rate of adverse events between the groups were assessed every 5 minutes and were compared using t-testing, Fisher's Exact test, or Analysis of Variance (ANOVA) where appropriate. The primary outcome of the study was incidence of hypotension and the secondary outcome was pain reduction as measured by the visual analog score and numeric rating score. A total of 207 patients were randomized with 187 patients included in the final analysis. Of the 187 patients, 99 were in the morphine group and 88 in the fentanyl group. No statistically significant difference between the two groups with respect to hypotension was found (morphine 5.1% vs. fentanyl 0%, p = 0.06). Baseline characteristics, necessity for additional dosing, and other adverse events between the two groups were not statistically different. There were no significant differences between the changes in visual analog scores and numeric rating scale scores for pain between the two groups (p = 0.16 and p = 0.15, respectively). This study supports that fentanyl and morphine are comparable in providing analgesia for ischemic-type chest pain. Fentanyl appears to be a safe and effective alternative to morphine for the management of chest pain in the prehospital setting.     

硫酸吗啡控释片阴道给药治疗女性癌痛的疗效观察

目的观察硫酸吗啡控释片(美施康定)阴道给药治疗女性癌痛的临床疗效。方法对入选的29例口服及直肠给药困难的女性癌痛患者予以美施康定阴道给药,1次/12 h。起始剂量结合剂量滴定设定,在用药过程中根据疼痛缓解程度调整剂量。观察阴道给药患者治疗前及疗程结束时的疼痛程度、KPS评分、不良反应发生率等,最后综合评定镇痛效果。结果美施康定阴道给药患者疼痛缓解总有效率和显著有效率分别为9 2.9%和7 5.0%,患者生活质量提高,主要不良反应为恶心呕吐、便秘和嗜睡。结论对于不能口服及直肠给药的女性癌痛患者,美施康定阴道给药是一种安全、有效、简便的给药途径。     

硫酸吗啡控释片直肠、阴道给药治疗女性癌痛的疗效

目的比较硫酸吗啡控释片(商品名:美施康定)直肠、阴道给药治疗女性癌痛的临床疗效。方法将入选的97例口服给药困难的女性癌痛患者按随机数字表法分成两组,直肠给药组48例,阴道给药组49例,两组均给予硫酸吗啡控释片,1次/12 h,并在用药过程中根据疼痛缓解程度调整剂量;5 d后比较两组镇痛效果、不良反应发生率、硫酸吗啡控释片用量以及治疗前后生活质量评分变化情况。结果硫酸吗啡控释片直肠、阴道给药治疗中重度癌痛女性总有效率分别为93.8%和91.7%,组间比较差异无统计学意义(P>0.05);两组生活质量治疗后均有提高,差异有统计学意义,但组间比较差异无统计学意义(P>0.05);阴道给药组便秘发生率较直肠给药组明显降低,硫酸吗啡控释片用量少(P<0.05)。结论对于各种原因所致不能口服或直肠给药的女性癌痛患者,阴道给药是一种安全、有效、简便的给药途径。     

Intranasal Fentanyl Versus Fentanyl Pectin Nasal Spray for the Management of Breakthrough Cancer Pain in Doses Proportional to Basal Opioid Regimen

The aim of this randomized, crossover, comparison study was to assess the analgesic and adverse effects of 2 nasal preparations, intranasal fentanyl (INFS) and fentanyl pectin nasal spray (FPNS), for breakthrough pain, given in doses proportional to opioid basal regimen. Each patient randomly received INFS or FPNS in doses proportional to opioid dosages used for background analgesia for 2 pairs of episodes. For each episode of breakthrough pain, pain intensity and adverse effects intensity were recorded just before starting the INFS or FPNS (T0) and 5 minutes (T5), 10 minutes (T10), and 20 minutes (T20) after the administration of the nasal drugs. Sixty-nine patients were studied. The mean age was 63.4 years, and 37 patients were males. For the present analysis, 188 episodes were considered. A statistical decrease in pain intensity was observed with both nasal drugs after 5, 10, and 20 minutes. A decrease in pain intensity of >33% was observed in 16, 102, and 159 treated episodes at T5, T10, and T20, respectively. Adverse effects were of mild nature in most cases or were preexistent because of basal opioid therapy. No differences were found in summed pain intensity difference 20 minutes after dosing. Most of patients did not find substantial preferences. INFS and FPNS were effective and well-tolerated treatments for breakthrough pain management. Both delivery systems, in doses proportional to the basal opioid regimen, provided significant analgesia within 10 minutes, without producing relevant adverse effects.PerspectiveThis article showed that INFS and FPNS in doses proportional to basal opioid regimen are equally safe and effective for the management of breakthrough pain in cancer patients. These data provide new insights on the use of nasal preparations of fentanyl.     

Efficacy and Safety of Oral or Nasal Fentanyl for Treatment of Breakthrough Pain in Cancer Patients: A Systematic Review

Formulations of fentanyl that use buccal, sublingual, or nasal transmucosal routes of administration have been developed for the treatment of BTP in opioid-tolerant patients with cancer. The purposes of this analysis were to identify and review published data describing the efficacy and safety of different oral or nasal transmucosal fentanyl formulations for treatment of cancer-related BTP, based on a critical analysis of scientific literature. Oral transmucosal or intranasal fentanyl is an effective treatment for management of BTP episodes due to a potent analgesic effect, rapid onset of action, and sustained effect. Furthermore, it is a reasonably safe treatment, causing generally mild adverse events not leading to treatment discontinuation. Nevertheless, further progress in standardizing methodology, definitions, and criteria used both in research and in clinical practice is needed in order to generate quality information allowing a better understanding of the comparable efficacy of available formulations of fentanyl. A more rigorous assessment of long-term safety is also needed to establish a balance between benefits and risks of the available options.     

吗啡皮下注射联合芬太尼透皮贴治疗中重度癌痛患者的并发症及其护理

目的探讨吗啡皮下注射联合芬太尼透皮贴治疗中重度癌痛患者的并发症及其护理。方法选取2010年5月至2011年5月在浙江省肿瘤医院治疗的30例中重度癌痛且口服缓释吗啡耐药患者,采用盐酸吗啡皮下注射,待患者疼痛稳定后将24h所需的盐酸吗啡总量转换成芬太尼透皮贴剂用量,长期维持使用,观察其并发症并给予对症处理。结果本组29例患者疼痛控制良好,1例患者疼痛控制失败。药物不良反应有便秘、恶心、呕吐、头晕、嗜睡、排便困难等,通过精心护理后缓解。结论吗啡皮下注射后芬太尼透皮贴剂长期使用能有效控制疼痛。治疗过程中应加强对早期不良反应的观察及处理,以避免严重并发症的发生。     

芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的比较

目的：比较芬太尼、吗啡分别联合罗哌卡因用于术后硬膜外镇痛的效果及不良反应的发生率。方法：择期肿瘤手术患者150例随机分为Ⅰ组、Ⅱ组、Ⅲ组各50例。Ⅰ组给予吗啡60—80μg／mL复合0．125％罗哌卡因100mL硬外镇痛;Ⅱ组给予芬太尼5-6μg／mL复合0．125％罗哌卡因100mL硬外镇痛;Ⅲ组单纯给予芬太尼20μg／kg静脉镇痛。比较三组术后不同时点VAS评分、Ramsay评分以及不良反应的发生率。结果：VAS评分三组间比较差异无统计学意义（P〉0．05）;Ⅲ组在术后12h、24h、48h的Ramsay评分显著高于其他组（P〈0．05）;恶心、呕吐、皮肤瘙痒的发生率Ⅱ组、Ⅲ组均显著小于Ⅰ组（P〈0．05）;头晕、嗜睡的发生率Ⅰ、Ⅱ组显著低于Ⅲ组（P〈0．05）。结论：芬太尼联合低浓度罗哌卡因用于术后硬膜外镇痛效果确切、不良反应发生率少。