氟比洛芬酯联合吗啡自控静脉镇痛治疗肝癌半肝切除术后疼痛的疗效观察

目的:观察氟比洛芬酯注射液联合吗啡自控静脉镇痛（patient-controlled intravenous analgesia,PCIA）治疗半肝切除术后疼痛的镇痛效果及不良反应。方法:半肝切除术患者50例,按照随机数字表法分为单纯吗啡PCIA对照组和氟比洛芬酯注射液联合吗啡PCIA实验组,每组25 例,连续观察72小时。分别就两组治疗后疼痛缓解、吗啡用量、爆发痛镇痛起效时间和不良反应等方面进行评价。结果:对照组疼痛缓解率为88.0%;实验组疼痛缓解率为92.0%,两组镇痛作用无显著性差异（P>0.05）。实验组在减少阿片类止痛药剂量,缓解疼痛时间,减轻阿片类药物引起恶心、便秘、嗜睡、谵语、延长排气发生率方面明显优于对照组(P<0.05)。结论:氟比洛芬酯注射液与吗啡联合治疗肝癌半肝切除术后疼痛,可减少阿片类药物用量,降低阿片类不良反应,促进术后恢复。     

小剂量氯胺酮辅助吗啡硬膜外自控镇痛治疗顽固性中、重度晚期癌痛

背景与目的:疼痛是晚期癌症患者最主要的症状,也是影响癌症患者晚期生活质量的主要问题,如何治疗顽固性中、重度晚期癌痛,同时不增加不良反应的发生率是癌痛治疗的最大难题.本研究观察小剂量氯胺酮辅助吗啡硬膜外自控镇痛(patient control epidural analgesia,PCEA)用于顽固性中、重度晚期癌痛患者的可行性及止痛效果.方法:选择56例中、重度晚期癌痛患者,均为经三阶梯药物治疗方案治疗未能很好控制疼痛,同时不良反应较大的患者.按入院前后随机分成2组,分别采用PCEA吗啡(A组)和小剂量氯胺酮联合吗啡PCEA(B组)方法镇痛.2组均采用PCEA方法,镇痛液2组均为200ml,A组内含吗啡20mg,B组内含吗啡20 mg,氯胺酮100 mg.采用上海博创电子泵,负荷量为5 ml,背景剂量均为2 ml/h,PeA为2 ml,锁定时间为15 min.分别在安装止痛泵后24、48 h采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度,统计2组不良反应发生率.结果:经治疗,2组病例疼痛明显缓解.治疗后24、48 h视觉模拟评分(VAS)A组为3.68、3.54,B组为2.26、1.52,2组经比较,差异有显著性(P<0.05).PCA按压次数和吗啡用量A组明显多于B组,B组生活总满意度明显高于A组.不良反应:恶心呕吐、便秘、嗜睡、皮肤瘙痒、尿潴留A组明显高于B组;呼吸抑制、幻觉发生率两组无差异.结论:经硬膜外小剂量氯胺酮辅助吗啡自控镇痛具有镇痛作用强、不良反应小等优点,适合有效治疗中、重度晚期顽固性癌痛.     

氢溴酸高乌甲素联合阿片类药治疗中重度神经病理性癌痛疗效观察

目的探讨氢溴酸高乌甲素联合阿片类药与单独应用阿片药治疗中重度神经病理性癌痛的疗效差别。方法2003年1月至2007年12月间我院肿瘤科收治了63例神经病理性癌疼痛患者,Karnofsky评分50～80分,随机分为两组,其中A组采用氢溴酸高乌甲素联合阿片类镇痛药（32例）;B组单用阿片类镇痛药（31例）;疼痛评估采用视觉模拟评分法（visual analogue scale,VAS）,分析第0、3、10天的变化;评价两组阿片药品的消耗量以及不良反应的发生率。结果A、B组的VAS评分基线值差异无显著性（P=0.452）。从疼痛的缓解程度来看,VAS评分下降程度A组要好于B组,差异有显著性（P〈0.05）;从阿片类药物的消耗来看,B组明显要多于A组;阿片不良反应B组多于A组（P=0.015）。结论氢溴酸高乌甲素联合阿片类药可以更好地治疗患者神经病理性癌痛,减少了阿片药品的用量,降低了因为阿片药带来的不良反应,是治疗中重度神经病理性癌痛安全有效的办法。     

羟考酮缓释片联合即释吗啡在癌痛滴定治疗中的镇痛效果及不良反应

目的:观察盐酸羟考酮缓释片（奥施康定）联合即释吗啡在中、重度癌痛滴定治疗中的镇痛效果及不良反应。方法:选择82例中重度癌痛患者,随机分为A组（即释吗啡）和B组（羟考酮缓释片联合即释吗啡）,通过使用阿片类药物镇痛,对镇痛疗效、起效时间、滴定达到稳态时间、生活质量及不良反应进行观察及评估。结果:两组镇痛效果均显著,比较无明显差异性（P＞0.05）。B组较A组镇痛起效时间明显缩短,比较有明显差异性(P＜0.05),B组较A组滴定达到稳态时间明显缩短,比较有明显差异性(P＜0.05);两组生活质量均明显提高,比较无差异性(P＞0.05);两组便秘及恶心呕吐等不良反应的发生率均低,比较无差异性(P＞0.05）。结论:羟考酮缓释片联合即释吗啡治疗中、重度癌痛起效快、镇痛效果好,不良反应轻。     

普瑞巴林联合阿片类药物治疗癌性神经病理性疼痛的临床研究

目的 观察普瑞巴林联合阿片类药物治疗癌性神经病理性疼痛（MNP）的疗效。方法 2011年8月至2014年1月间52例中度以上MNP患者采用简单随机抽样法分为：A组（17例）,仅接受吗啡;B组（18例）,接受吗啡加75mg普瑞巴林（每日2次）;C组（17例）,接受吗啡加150mg普瑞巴林（每日2次）。患者采用静脉自控镇痛（PCIA）方式给予吗啡注射72h,滴定其所需剂量。72h后将吗啡换成口服羟考酮控释片,继续治疗4周。分析A、B、C 3组每24h吗啡用量,PCIA期间及口服羟考酮控释片后的疼痛情况（爆发痛次数、静息以及活动VAS评分）并记录不良反应。结果 与A组比较,B组72h内、C组48h内及72h内的每24h吗啡用量较低,差异均有统计学意义（P＜0.05）;C组72h内爆发痛次数及活动VAS评分均低于A组,差异有统计学意义（P＜0.05）;吗啡PCIA滴定期间,3组均未出现严重不良反应,常见不良反应为恶心、呕吐、头晕、嗜睡及便秘,组间差异均无统计学意义（P＞0.05）;A组第28天羟考酮缓释片用量（mg）为117.67±36.39,而B、C组分别为94.06±25.38和88.21±24.46,均低于A组,差异有统计学意义（P＜0.05）;B、C组第7、14、28天爆发痛次数均低于A组,差异有统计学意义（P＜0.05）;B组第14天活动VAS评分低于A组,C组第7、14天活动VAS评分均低于A组,以上差异均有统计学意义（P＜0.05）。结论 普瑞巴林联合阿片类药物治疗MNP的效果较好,优于单用阿片类药物,且普瑞巴林可能需使用较大的剂量。     

病人自控式镇痛泵静脉泵入吗啡治疗难治性癌痛的临床效果观察

目的:观察使用病人自控式镇痛泵静脉泵入吗啡治疗难治性癌痛的临床效果。方法:筛选难治性癌痛患者32例,采用PCA泵静脉泵入吗啡注射液止痛治疗。回顾性分析上述病例患者的临床特征,观察镇痛过程,评价PCA泵的镇痛疗效和安全性。结果:多数难治性癌痛患者对吗啡的需求量增加,使用PCA泵静脉泵入吗啡能快速及有效的镇痛,患者的疼痛程度明显减轻,生活质量显著改善,无严重不良反应发生。结论:使用PCA泵治疗难治性癌痛,合理控制吗啡使用剂量,操作简单,提高患者用药的依从性,能够快速、及时和有效镇痛。     

阿片类药物静脉应用及多模式镇痛下的癌痛治疗

难治性癌性疼痛是全球肿瘤和疼痛医师所面临的治疗难题。虽然较多癌痛患者在疾病早期能获益于口服镇痛药物,但是对于疾病晚期和已出现难治性癌痛的患者,单纯的阿片类药物口服治疗效果较差,而此时将阿片类药物的给药途径更换为静脉仍然是最常使用的快速镇痛方法。目前,随着阿片类药物经静脉患者自控镇痛（patient controlled intravenous analgesia,PCIA）的临床实践不断增加,对该方式的适应证、药物选择、滴定等问题均有了更为深入的探讨。此外,在多模式镇痛的快速发展中,癌痛治疗的个体化措施有了更广阔的延伸空间。本文将对上述问题分别进行综述,旨在对难治性癌痛治疗方案的优化提供参考。      

羟考酮联合纳洛酮治疗癌痛的研究进展

许多患有癌症的人都有中度至重度的疼痛需要使用强效的镇痛药来缓解疼痛。阿片类药物为治疗晚期癌痛的主要药物（如吗啡、羟考酮等）。羟考酮是一种强效的阿片类镇痛药，可快速透过血脑屏障，口服给药后生物利用度高。但阿片类药物常常伴有很多的不良反应:恶心、呕吐、便秘、成瘾等，而羟考酮与纳洛酮联合用药不仅可以缓解病人的疼痛，而且可以减少不良反应的发生。本文对羟考酮联合纳洛酮对疼痛的治疗进展作一综述。     

硫酸吗啡缓释片联合氟哌噻吨美利曲辛片治疗22例癌性疼痛

[目的]观察硫酸吗啡缓释片联合氟哌噻吨美利曲辛片治疗癌性疼痛的效果。[方法]44例晚期癌痛患者随机分为单药组和联合组,每组22例。单药组每12h口服硫酸吗啡缓释片30mg1次;联合组每12h口服硫酸吗啡缓释片30mg1次,每天口服氟哌噻吨美利曲辛片1片。用数字疼痛评估法（NRS）记录疼痛评分,根据综合性医院焦虑抑郁（HAD）情绪测定表评价患者焦虑抑郁情况。观察21d,评价两组患者疼痛缓解率、疼痛评分、硫酸吗啡缓释片使用剂量、不良反应及焦虑抑郁情况。[结果]两组治疗后各级癌痛缓解率、硫酸吗啡缓释片平均使用剂量以及各不良反应发生率均无显著性差异（P〉0.05）。治疗后联合组焦虑/抑郁评分分别为8.19±1.94和9.29±2.10,均较单药组的10.80±2.12和11.85±2.28低,均有统计学差异（P〈0.01）。[结论]硫酸吗啡缓释片联合氟哌噻吨美利曲辛片能进一步改善癌痛患者焦虑抑郁状况,氟哌噻吨美利曲辛片未减少硫酸吗啡缓释片治疗癌痛的剂量。     

奥施康定联合罗通定治疗老年晚期癌痛患者中重度疼痛的临床研究

目的：观察奥施康定（盐酸羟考酮缓释片）联合罗通定用于治疗老年晚期癌痛患者中重度疼痛的治疗效果、疼痛自我效能感、不良反应及生活质量改善情况。方法：将160例老年晚期中重度癌痛患者随机分为A、B、C三组,A组53例采用硫酸吗啡缓释片治疗,B组53例采用盐酸羟考酮缓释片治疗,C组54例采用盐酸羟考酮缓释片联用罗通定治疗,根据患者疼痛控制情况调整患者用药剂量,从而达到有效的镇痛效果,并观察患者生活质量改善情况、不良反应及评定患者的疼痛自我效能感。结果：A组（硫酸吗啡缓释片组）总有效率为92．5％,B组（盐酸羟考酮缓释片组）总有效率为88．7％,C组（盐酸羟考酮缓释片＋罗通定组）总有效率为94．4％,三组总有效率差异无统计学意义（P＞0．05）,B组盐酸羟考酮缓释片的最终滴定剂量为（204．03±30．45）mg/天,C组盐酸羟考酮缓释片的最终滴定剂量为（163．67±25．49）mg/天,C组与B组相比差异有统计学意义（P＜0．05）;三组患者治疗后生活质量均较治疗前明显改善（P＜0．05）,与B组相比,C组的生活质量改善显著（P＜0．05）,但B组和A组相比,差异无统计学意义（P＞0．05）;疼痛自我效能感较治疗前明显提高（P＜0．05）,与B组相比,C组的疼痛自我效能感更高（P＜0．05）;三组患者治疗过程中的不良反应以嗜睡和便秘常见,其次是恶心、呕吐,无呼吸抑制及成瘾性的发生。结论：罗通定可增强盐酸羟考酮的镇痛、镇静作用,降低其抑制癌痛的用药剂量,两者联用在治疗老年晚期癌痛患者中重度疼痛方面安全有效性高,不良反应小,生活质量明显提高,管理疼痛及疼痛相关症状的能力增强,具有重要的临床推荐价值。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.