缓释芬太尼透皮贴剂对比控释盐酸吗啡在癌痛治疗中的临床研究

目的:比较缓释芬太尼透皮贴剂(多瑞吉)与控释盐酸吗啡(美菲康)对中重度癌痛患者的止痛效果、不良反应和生活质量改善情况。方法:42例癌痛患者随机分为两组,分别应用缓释芬太尼透皮贴剂和控释盐酸吗啡进行治疗,用药15天后评价疼痛缓解率、生活质量改善情况及不良反应。结果:芬太尼透皮贴剂组(治疗组)20例患者疼痛缓解有效率为90.0%,控释吗啡组(对照组)22例患者疼痛缓解有效率为81.8%,两组无统计学差异(P>0.05);不良反应方面,两组便秘发生率分别为30.0%和63.6%,有统计学意义(P<0.05),两组恶心呕吐发生率分别为25.0%和54.5%,有统计学意义(P<0.05);两组之间在生活质量改善方面无显著性差异。结论:芬太尼透皮贴剂及控释盐酸吗啡对中、重度癌痛疗效相似,但使用芬太尼透皮贴剂患者便秘、恶心及呕吐现象发生率更低。     

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。     

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。     

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，能够明显改善患生活质量，毒副作用轻微，给药方便。     

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晚期癌痛的效果观察

目的观察芬太尼透皮贴剂治疗癌痛的效果。方法对41例中、重度癌痛患者采用芬太尼贴剂治疗,观察比较治疗前后疼痛缓解率和生活质量评分。结果中度癌痛患者疼痛缓解率100％,重度癌痛缓解率92．8％;癌痛患者生活质量治疗前后比较,差异有统计学意义（p〈0．01）。不良反应主要有头晕、恶心呕吐、便秘、皮肤瘙痒、排尿困难。结论芬太尼透皮贴剂治疗癌痛使用方便,不良反应轻,镇痛作用强、疗效稳定、安全。掌握正确使用的方法,加强心理护理,密切观察药物不良反应、及时采取针对性护理措施,是提高患者用药依从性的关键。     

癌痛患者应用芬太尼PCIA滴定和芬太尼透皮贴剂引起不良反应的护理对策

目的总结癌痛患者芬太尼静脉自控镇痛(PCIA)滴定和芬太尼透皮贴剂引起不良反应的护理对策。方法对26例癌痛患者应用芬太尼PCIA滴定和芬太尼透皮贴剂,总结治疗过程中不良反应的护理经验。结果 26例癌痛患者在治疗过程中出现便秘2例、恶心、呕吐15例、头晕、嗜睡4例、谵妄1例、肌阵挛1例,均给予针对性护理措施后好转。结论熟悉并掌握阿片类药物常见不良反应的观察和护理,加强患者及家属的宣教可减少不良反应的发生,从而提高患者的生活质量。     

芬太尼透皮贴剂与口服吗啡控释片治疗老年中重度癌痛疗效比较

目的比较芬太尼透皮贴剂与口服吗啡用于老年癌痛患者的疗效和不良反应。方法86例老年癌痛患者，随机分为两组。A组使用芬太尼透皮贴剂，B组口服吗啡控释片，比较两组的疗效和不良反应情况。结果两组用药后止痛效果明显，A组总缓解率90．70％，B组总缓解率93．02％，差异无显著性（P〉0．05）；A组不良反应明显低于B组，差异有显著性（P〈0．05），尤其死两组便秘发生率有极显著差异（P〈0．01）。结论芬太尼透皮贴剂镇痛安全方便，疗效确切，是治疗老年中重度癌痛的理想药物。     

芬太尼透皮贴剂治疗老年人晚期癌痛的观察

目的 观察芬太尼透皮贴剂对＞70岁老年晚期癌痛病人止痛效果,及其不良反应。方法观察42例年龄＞70岁的晚期肿瘤并中度以上疼痛患者,使用芬太尼透皮贴的疗效及不良反应、合适剂量及其安全性。结累 完全缓解（CR）32例,部分缓解（PR）8例,轻度缓解（MR）2例,总有效率100％,CR＋PR95．25％;不良反应有头晕、嗜睡、恶心、呕吐、便秘。结论 芬太尼透皮贴能有效的控制老年晚期肿瘤患者中度以上疼痛,剂量以2．5mg为常用,特别适用于不能口服药物及使用吗啡控释片出现严重不良反应者,不良反应较少,多在一周内消失,老年病人使用安全,能有效地提高老年肿瘤病人的生存质量．     

Economic evaluation of the fentanyl transdermal system for the treatment of chronic moderate to severe pain

The fentanyl transdermal system (Duragesic) is an opioid analgesic indicated for the management of chronic moderate to severe pain. The purpose of this analysis is to estimate its economic value compared to two long-acting oral opioids. A cost-utility analysis was performed using a three-phased decision analytic model. The transdermal system had the highest expected cost during the first year of therapy ($2,491), moderately higher than the cost of a year of therapy with controlled-release morphine ($2,037) or controlled-release oxycodone ($2,307). The system also had the highest expected number of quality-adjusted life-days (QALDs) (244 compared to 236 for morphine and 231 for oxycodone), despite conservative assumptions. The fentanyl transdermal system achieved incremental cost-utility ratios of $20,709 (vs. morphine) and $5,273 (vs. oxycodone) per quality-adjusted life year (QALY) gained. In a conservative modeled analysis, the fentanyl transdermal system led to increased QALDs at a nominal increased cost. In the absence of head-to-head clinical trials, models help clarify cost and outcome trade-offs and provide a consistent theoretical framework for use by individual decisionmakers.     

不同途径应用盐酸羟考酮控释片治疗中重度癌性疼痛临床效果观察

目的：观察应用盐酸羟考酮控释片（TM）口服和经直肠不同途径给药对中重度癌性疼痛的疗效和不良反应。方法：61例伴有中重度疼痛的癌症患者随机分A组（口服TM）31例和B组（经直肠应用TM）30例。分别应用≤60mg／d和〉60mg／d两个剂量组，对TM的不同程度疼痛的疗效和不良反应进行观察。结果：A组患者维持剂量≤60mg／d和〉60mg／d的有效率分别为83．3％、85．7%，而B组患者分别为81．8％、87．5％，两组无明显差异（P〉0．05）；并且进一步对A、B两组不同的疼痛分级、不同的疼痛类型的止痛效果分析，均无统计学差异（P〉0．05）；另外，A、B两组的不良反应如恶心、呕吐、便秘、排尿困难、嗜睡等均无统计学差异（P〉0．05）。结论：经口服和直肠应用TM的疗效和不良反应相近，对重症且进食、进水、吞咽困难者或肠道肿瘤致肠梗阻者经直肠应用TM是有效、安全、方便的镇痛方法之一。     

Transdermal fentanyl.

OBJECTIVE: To review the use of transdermal fentanyl for the treatment of moderate to severe chronic pain. The article provides background on the pharmacology and pharmacokinetics of the drug, as well as the properties of the transdermal system. In addition, clinical trials, adverse effects, and therapeutic considerations and recommendations are presented. DATA SOURCES: Clinical trials, review articles, and reference texts. STUDY SELECTION: Comparative clinical trials involving the use of transdermal fentanyl on postoperative and chronic pain patients. DATA EXTRACTION: Data from clinical human trials published in the English language were reviewed. Trials were assessed by sample size, opioid dosage regimen, and therapeutic outcome. DATA SYNTHESIS: Transdermal fentanyl was found to be effective in the control of chronic and postoperative pain. In one trial the overall patient satisfaction with pain control was 79 percent for the transdermal fentanyl group and 44 percent for the placebo group. In another trial, the amount of additional parenteral morphine was significantly lower for the group receiving transdermal fentanyl than for the placebo group (49.9 +/- 4.9 vs. 77.0 +/- 6.3 mg, respectively, p < 0.01). The most common adverse effects recorded were nausea (45-85 percent), pruritus (14-60 percent), and sedation (40-59 percent). The cost of analgesic therapy with this delivery system is higher than that of parenteral opioid analgesia, but less than patient-controlled analgesia. CONCLUSIONS: The transdermal fentanyl formulation offers some minor advantages over other forms of conventional pain management. Results of early clinical trials are promising, but more studies are needed to evaluate its long-term effectiveness and adverse effects. Specifically, comparisons with standard parenteral and patient-controlled opioid analgesia in chronic malignant and nonmalignant pain are necessary for adequate evaluation of transdermal fentanyl.     

盐酸美沙酮片治疗晚期癌症疼痛的临床观察

目的:比较美沙酮与硫酸吗啡控释片治疗中、重度癌痛的止痛效果和不良反应。方法:60例中、重度癌痛患者(应用第二阶梯止痛药不能缓解者),随机分为两组,治疗药物分别为美沙酮组和美施康定组,在用药后15天评价疼痛缓解率及不良反应。结果:疼痛缓解率美沙酮组为83.3％(25/30),美施康定组86.7％(26/30),差异无显著性(P>0.05)。美施康定组便秘、恶心及呕吐发生率显著高于美沙酮组,差异有显著性(P<0.05)。结论:美沙酮由于对中、重度癌痛的止痛效果好,副作用低,为治疗中、重度癌痛较好的药物。     

出院患者使用强阿片类镇痛药物的随访分析

目的：了解我院中重度疼痛患者出院后使用强阿片类镇痛药物的依从性和不良反应。方法：采集我院2020年 8月-9月出院开具强阿片类镇痛药品（硫酸吗啡缓释片，规格30mg、10mg；盐酸羟考酮缓释片，规格40mg、10mg；芬太尼透皮贴剂，规格4.2mg、2.5mg、4.125mg）的患者信息，并对患者进行电话随访，比较各组临床资料及随访数据差异。结果：总计获得291例疼痛患者出院带药数据。三种强阿片类镇痛药物在患者个人一般情况、电话应答率、疼痛类型、合并使用其他镇痛药比例等方面存在显著差异。吗啡缓释片组存在用药顾虑的患者比例最高，为18.4%，显著高于另外两组（P＜0.001）。吗啡缓释片组、羟考酮缓释片组及芬太尼透皮贴剂组不良反应发生率分别为45.65%、24.14%及14.29%，差异有统计学意义(P=0.001)。三组药物在用药依从性和疼痛控制效果方面无明显差异。结论：疼痛的处理除了遵守“WHO三阶梯止痛应用原则”选择合适的镇痛药物控制疼痛外，还和患者个人生活习惯、规范用药和正确药物认知存在必然联系，药师应积极转变药学服务模式，指导服务覆盖出院后患者，促进合理、规范、有效地使用医生开具的镇痛药物，缓解疼痛的同时，减少和避免不良反应，提高患者生存质量。     

多瑞吉治疗癌痛的疗效观察

Cancerpainisoneofthemostcommonsymptomsinthepatientswithcancer，itisestimatedthatabout７０％latestagepatientswithcanceraresufferingfromcancerpain．Itisveryimportantfortheclinicaloncologiststocontrolthissymptom．Opioiddrugsarethefirstchoicetotreatmoderatetoseverepain．In１９９９，transdermalFen－tanyl（Durogesic）begantouseintroducedbyXianJanssen．Durogesicprovidesanewmethodtocontrolcancerpain．FromMarch２０００toJanuary２００２，wetreated３０patientswithmoderatetoseverecancerpain，theeffecti…     

A Network Meta-Analysis of the Efficacy of Opioid Analgesics for the Management of Breakthrough Cancer Pain Episodes

ContextWith many medications available for the management of breakthrough cancer pain (BTCP), physicians may require additional guidance in selecting an appropriate medication to suit an individual patient's needs.ObjectivesTo identify all the evidence and assess the relative clinical value of currently approved BTCP medications.MethodsFollowing a systematic literature search (2007–2010), the results of 10 randomized controlled trials investigating the effects of BTCP medications (intranasal fentanyl spray [INFS], fentanyl pectin nasal spray, fentanyl sublingual tablets, fentanyl buccal soluble film, fentanyl buccal tablets, oral transmucosal fentanyl citrate, and morphine sulfate immediate release) were synthesized using a network meta-analysis. The main outcome was pain intensity difference (PID) relative to placebo up to 60 minutes after the intake of medication.ResultsINFS, fentanyl pectin nasal spray, fentanyl buccal tablet, and oral transmucosal fentanyl citrate showed greater PIDs relative to placebo than other BTCP medications 15 minutes after intake. All other medications showed greater PIDs relative to placebo at 30 minutes, except morphine sulfate immediate release, which did not show efficacy over placebo until 45 minutes. Only INFS produced clinically meaningful pain relief (absolute PID ≥2) at 15 minutes.ConclusionFrom current evidence, although all BTCP medications provided pain relief within the time frames assessed, transmucosal fentanyl medications achieved a greater level of pain relief in a shorter time frame than placebo or oral morphine.     

Transdermal fentanyl: informed prescribing is essential.

While morphine is historically the gold standard for the management of severe cancer pain, some patients either do not achieve adequate analgesia, or suffer intolerable side-effects. For these patients an alternative opioid is recommended. One such alternative is the potent mu opioid agonist fentanyl, delivered in a transdermal controlled release formulation. Similar to morphine, transdermal fentanyl is effective for the management of moderate to severe cancer pain. However, inappropriate prescribing of transdermal fentanyl, particularly in the clinical setting of unstable pain, can cause significant opioid toxicity, as highlighted in the case reports described.