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。     

芬太尼透皮贴剂治疗重度癌痛

目的：观察芬太尼透皮贴剂治疗晚期癌症患者重度疼前的临床镇痛疗效、不良反应。方法：对46例晚期癌症重工疼痛患者进行为期18-182d的止痛治疗,初始剂量25ug/h,然后根据患者疼痛的缓解情况进行剂量滴定,使患者达到无痛或基本不痛,同时记录治疗前后疼痛强度及用药过程的不良反应,用药期间未行抗肿瘤治疗。结果：91.3%的重度疼痛获得中度缓解或消失,86.9%患者个体剂量为25-50ug/h,未见严重副反应。结论：芬太尼透皮贴剂对重度癌痛具有肯定的镇痛疗效。用药安全方便。     

芬太尼透皮贴剂治疗晚期癌痛40例

目的:使用多瑞吉117例中,对40例晚期重度癌性疼痛患者应用多瑞吉(芬太尼透皮贴剂)的疗效和不良反应进行临床评价.方法:采用多瑞吉剂量逐渐递增的办法,调整剂量达到24小时无疼痛或基本不痛,每72小时更换多瑞吉一次,应用至少4周以上.观察指标包括疼痛评分,疼痛缓解率,生活质量及不良反应.结果:40例治疗超过30天,占34%,接受贴剂治疗的平均时间为38.3天.VAS评分由用药前的平均8.23,降至平均3.47,用药后疼痛明显减轻,疼痛缓解率较高.疼痛的中度以上缓解率为86.0%,明显以上缓解率为63.2%.患者的生活质量得到一定程度的改善.主要副反应有恶心、便秘、嗜睡等,患者易于耐受.结论:芬太尼透皮贴剂可以有效地控制晚期癌性疼痛,改善生活质量,副作用小.     

芬太尼透皮贴剂治疗晚期癌痛的观察及护理

目的：本文研究分析和总结芬太尼(多瑞剂)透皮贴剂对晚期癌症患者疼痛治疗的效果、粘贴方法及镇痛过程中的相关问题。方法：晚期癌痛患者45例持续使用多瑞吉(外贴)25—50μg／h观察治疗过程中镇痛效果，心理护理的作用，使用中粘贴方法及引起不良反应的处理。结果：多瑞吉贴剂按症确的粘贴方法，充分做好患者的心理护理，可以有效地缓解中、重度晚期癌症患者疼痛。不良反应以恶心、呕吐、便秘最为多见。结论：多瑞吉应用的心理护理，正确的粘贴方法，能影响药物的使用疗效和患者的依从性，对晚期癌痛治疗疗效好，使用方便，不良反应经对症处理多能缓解。     

芬太尼透皮贴剂治疗老年癌痛的整体护理

疼痛是癌症患者常见的主要症状，作者对自2001年2月至2003年8月使用芬太尼透皮贴剂(多瑞吉)控制患者癌痛，取得了一定疗效。现将护理体会介绍如下。     

芬太尼透皮贴剂治疗晚期癌痛的观察及护理对策

目的探讨芬太尼透皮贴剂(多瑞吉)治疗晚期癌痛的效果及护理对策。方法224例中、重度癌痛患者给予多瑞吉镇痛治疗，剂量为25～50μg/h，贴膜每3d更换1次，时间15．178d，评估患者止痛效果、不良反应及生活质量改善情况。结果总的疼痛缓解率96．4％，绝大多数不良反应能缓解，病人生活质量明显提高。结论多瑞吉治疗晚期癌痛疗效明显，辅助相应的护理措施，效果更显著，不良反应少，能够改善患者的生活质量。     

晚期癌痛应用芬太尼透皮贴剂治疗与护理

2002年10月～2003年10月，我们应用芬太尼透皮贴剂治疗晚期癌痛与护理，取得点滴经验，现小结如下。     

芬太尼透皮贴剂在三阶梯癌痛治疗中的临床观察

目的：观察芬太尼透皮贴剂(多瑞吉)在三阶梯癌痛治疗中的临床疗效、不良反应及使用后患者生活质量的改善程度。方法：选取50例伴严重疼痛的恶性肿瘤患者，按照WHO三阶梯癌痛治疗原则，经一、二阶梯用药一周后，仍有中度疼痛残余甚或疼痛加剧者，加用多瑞吉止痛。记录使用多瑞吉前后的疼痛强度，生活质量评分和用药中的不良反应。结果；多瑞吉使用后疼痛完全缓解29例(58％)，部分缓解20例(40％)，轻度缓解1例(2％)；不良反应有嗜睡、便秘、头晕等，无危及生命的严重不良反应，生活质量明显改善。结论：多瑞吉在三阶梯癌痛治疗应用中疗效显著，使用方便，副作用少，能明显改善癌症患者的生活质量，值得临床推广应用。     

芬太尼透皮贴剂治疗晚期癌痛的观察及护理对策

目的　探讨芬太尼透皮贴剂 (多瑞吉 )治疗晚期癌痛的效果及护理对策。方法　 2 2 4例中、重度癌痛患者给予多瑞吉镇痛治疗 ,剂量为 2 5～ 5 0 μg/h ,贴膜每 3d更换 1次 ,时间 15～ 178d ,评估患者止痛效果、不良反应及生活质量改善情况。结果　总的疼痛缓解率 96 .4 % ,绝大多数不良反应能缓解 ,病人生活质量明显提高。结论　多瑞吉治疗晚期癌痛疗效明显 ,辅助相应的护理措施 ,效果更显著 ,不良反应少 ,能够改善患者的生活质量     

芬太尼透皮贴与吗啡治疗癌痛效果的Meta分析

目的：评价芬太尼透皮贴和吗啡缓释片在控制中重度癌痛的效果及不良反应的情况。方法以“芬太尼透皮贴∕多瑞吉∕吗啡∕美菲康∕癌症∕癌痛∕随机∕对照”为关键词,检索公开发表的相关随机对照试验。根据澳大利亚JBI循证卫生保健中心对RCT的评价原则进行文献评价,采用RevMan 5．0软件对本系统评价关注的结局指标进行M eta分析。结果共纳入10篇文献,疼痛缓解率差异无统计学意义,头晕嗜睡、恶心呕吐、便秘发生率差异有统计学意义。结论芬太尼透皮贴剂和口服吗啡控释片治疗中重度癌痛的效果相近,但芬太尼透皮贴剂头晕嗜睡、恶心呕吐、便秘等主要不良反应的发生率较低。     

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。     

芬太尼透皮贴剂在普外术后镇痛中的应用

目的探讨芬太尼透皮贴剂（5 mg/贴）对普外科术后病人的镇痛效果及安全性。方法分别选择住院接受腹腔镜下胆囊切除术、痔外剥内扎术及甲状腺次全切或部分切除术的病人各20例,各组再设实验组及对照组各10例。观察实验组在应用芬太尼透皮贴剂后,术后疼痛是否较对照组有所减轻,以及副反应发生情况。结果应用芬太尼透皮贴剂组病人术后疼痛明显较对照组减轻,术后副反应发生率比较差异无统计学意义。结论应用芬太尼透皮贴剂于普外术后镇痛,是一种方便、有效且安全的方法。     

芬太尼离子导入给药装置自控镇痛与癌痛治疗

芬太尼离子导入给药装置(ITS)患者自控镇痛(PCA)实现了无损伤给药和自控给药,对术后急性疼痛的控制效果满意,可能对癌痛治疗也会发挥较好的镇痛效果.本文重点介绍离子药物导入技术、芬太尼ITS、经皮芬太尼主动和被动转运给药药代动力学.     

Use of a lidocaine patch in the management of postsurgical neuropathic pain in patients with cancer: a phase III double-blind crossover study (N01CB)

Objective  Current therapies often have limited efficacy and untenable side effects when used to treat persistent incisional pain following cancer-related surgery. Lidocaine patches reduce neuropathic pain from herpes zoster but their benefits for persistent cancer-related postsurgical incisional pain remain unclear. Study design  Multicenter, double-blind, randomized, two-period crossover trial. Materials and methods  Twenty-eight cancer patients with postsurgical incisional pain were randomly assigned to receive either lidocaine patches followed by placebo patches or the reverse. Each study period lasted 4 weeks. Patches were applied daily upon waking and left in place for a maximum of 18 h. The primary outcome measure, an 11-point pain intensity rating scale, was administered weekly. Secondary outcomes were administered weekly (Brief Pain Inventory-Short Form(BPI-SF), Subject Global Impression of Change) and at the end of each study period (Short Form-Magill Pain Questionnaire, Linear Analogue Self Assessment Scale, Neuropathy Pain Scale, Pain Catastrophizing Scale, Profile of Mood States Short Form). Results  Twenty-one patients completed the first period and 18 completed their crossover second phase. No significant intergroup differences were detected in pain intensity ratings. Few secondary end points were significantly different when subjects used the lidocaine versus placebo patches. BPI-SF interference scores were lower in patients using the lidocaine patch during the first study period, including several scores that achieved statistical significance, general activity (p = 0.02), work (p = 0.04), and relations with others (p = 0.02). Conclusion  Lidocaine patch use did not significantly reduce pain intensity ratings or the majority of related secondary end points in cancer patients with persistent incisional pain. This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grants CA-25224, CA-37404, CA-35103, CA-35119, CA-35415, and CA-35113. Additional participating institutions include: Medcenter One Health Systems, Bismarck, ND 58501, USA (Edward J. Wos, M.D.); Illinois Oncology Research Assn. CCOP, Peoria, IL 61615-7828, USA (John W. Kugler, M.D.); Abbott Northwestern Hospital, Minneapolis, MN 55407, USA (Daniel M. Anderson, M.D.); Siouxland Hematology–Oncology Associates, Sioux City, IA 51105, USA (Donald B. Wender, M.D.)     

Is there a ceiling effect of transdermal buprenorphine? Preliminary data in cancer patients

Objective The aim of this preliminary study was to explore the possibility of using higher doses of transdermal buprenorphine (TD-BUP) than those commonly used and available as manufactured patches, which are based on the assumption that BUP may have a ceiling effect that has never been determined yet. Materials and methods Ten patients who were already receiving TD-BUP (70 μg/h, which is about 1.6 mg/day) and were no longer responsive to this dosage were administered higher doses up to a maximum of 140 μg/h within 6 days, when the study was completed. Results In six patients, dose increments of TD-BUP were effective, and patients achieved adequate analgesia within 6 days. Four patients discontinued the treatment due to inefficacy of TD-BUP 140 μg/h and were switched to other opioids until achieving stabilization (oxycodone 320 and 400 mg/day, methadone 120 mg/day, transdermal fentanyl 200 μg/h). This group of patients required higher doses than those chosen for TD-BUP, underlying the need to escalate the dose rapidly, a modality not accomplished with transdermal drugs. Adverse effects did not change and were similar to those observed before increasing the dose of TD-BUP. On the basis of these preliminary data, patients requiring doses higher than 70 μg/h of TD-BUP, in the range of 105–140 μg/h, may still have an analgesic benefit without important consequences in terms of adverse effects. It cannot be excluded that even higher doses may be effective, as some patients required rapid titration with higher morphine equivalent doses, and according to the protocol, other opioids were provided to facilitate this process. Further studies should clarify the role and the benefit of TD-BUP in specific clinical circumstances.     

老年胸痛的诊断与预后

胸痛是老年人就诊最常见的症状之一。在我国,老年胸痛的误诊和漏诊率较高。本文的目的在于对老年胸痛的流行病学、胸痛的机制、胸痛的病因和分类、胸痛的临床表现与危险性评估、老年胸痛的治疗及预后进行概述,以期规范老年胸痛的评估和诊断,进而提高老年胸痛的诊治水平并合理使用医疗资源。     

老年癌痛病人的护理进展

综述老年癌痛病人的护理进展,包括疼痛的评价工具、老年癌痛的治疗及护理。     

老年病人慢性疼痛的护理研究进展

探讨老年病人慢性疼痛的护理问题,从老年病人慢性疼痛易被忽视的因素,包括老年病人自身因素和医务人员因素、老年病人慢性疼痛的评估及行之有效的护理措施和如何进行药物和非药物干预3个方面进行研究,以提高对老年慢性疼痛病人的护理和生活质量。