门诊癌痛患者阿片类药物应用情况及合理性分析

目的：探讨门诊癌痛患者阿片类药物应用情况及合理性。方法：选取2020年6月—2021年6月就诊的门诊癌痛患者开展研究,分析药物使用类型、镇痛药物不合理使用情况。结果：220例患者口服镇痛药物当中,使用强阿片类药物及复方制剂占比最高为65.00%;镇痛药物不合理使用情况中排名前三的为患者口服镇痛药物存放不当（74.09%）、用药频次不规范（45.00%）和药品不良反应处理不当（43.64%）。结论：门诊癌痛患者阿片类药物应用效果较明显,能够有效缓解疼痛的情况,存在药品存放不当、用药频次不当、不良反应处理不当等不合理用药情况,需加强患者用药教育,避免不合理用药。     

规范化癌痛治疗中阿片类药物合理使用探析

针对我国阿片类药物的使用现状及疼痛治疗认识与实践上的误区,阐述规范化癌痛治疗中合理使用阿片类药物应注意的问题以促进和保障癌症患者无痛,并提高其生存质量。     

癌痛患者使用阿片类药物镇痛的个体化护理干预及效果

目的 探讨癌痛病患使用阿片类药物镇痛的个体化护理干预及效果.方法 筛选出我院收治的82例癌痛病患,所有病患均使用阿片类药物镇痛,按照不同护理干预方法将其分成护理组A与护理组B各41例,护理组A实行常规护理干预,护理组B实行个体化护理干预,对比其效果.结果 对比两组病患治疗后的疼痛程度评分,护理组B比护理组A低,差异显著(P<0.05);对比两组病患治疗后的焦虑与抑郁程度评分,护理组B比护理组A低,差异显著(P<0.05);护理组A的患者满意度是87.8%,护理组B是97.6%,护理组B比护理组A高,对比差异显著(WTBXP<0.05).结论 癌痛病患使用阿片类药物镇痛的个体化护理干预的效果满意,可明显缓解病患疼痛,改善其心理状态,且有助于提升患者满意度,值得推荐.     

复旦大学附属肿瘤医院2008-2011年癌痛病人阿片类药物应用分析

阿片类药物的合理应用是癌痛治疗合理用药工作中的重要内容。本文对复旦大学附属肿瘤医院2008—2011年用于癌痛治疗的阿片类药物的使用数据进行了汇总分析,以了解阿片类药物的使用趋势,为阿片类药物的合理使用和癌痛病人获得允分治疗提供依据。     

OPRM1基因A118G多态性对癌痛患者阿片类药物使用剂量影响的Meta分析

摘 要 目的：系统评价μ阿片受体基因（OPRM1）A118G多态性对癌痛患者阿片类药物使用剂量的影响,为其个体化用药提供参考。方法：计算机检索The Cochrane Library、PubMed、Embase、Medline、CNKI、WanFang Data和VIP数据库,搜索有关癌痛患者OPRM1基因A118G多态性和阿片类药物使用剂量的相关文献,检索年限均从各数据库建库起至2017年12月31日。由两位评价员独立筛选文献、提取资料、评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果：纳入5项研究,共459例患者。OPRM1基因A118G多态性检测结果分为突变纯合子（GG）基因型、野生杂合子（AG）基因型、野生纯合子（AA）基因型。Meta分析结果显示：GG基因型患者阿片类镇痛药的需要量较AG基因型高[SMD=-39.74,95%CI（-59.20,-20.28）,P＜0.001];GG基因型患者阿片类镇痛药的需要量较AA基因型高[SMD=-48.77,95%CI（-68.01,-29.53）,P＜0.000 1]。结论：基于目前研究表明OPRM1基因A118G 单核苷酸多态性与患者阿片类镇痛药物使用剂量有相关性,携带G等位基因的癌痛患者阿片类药物的使用剂量更多。     

北京大学肿瘤医院门诊患者2008-2017年强阿片类药物使用分析

目的:分析北京大学肿瘤医院(以下简称我院)门诊近10年强阿片类药物用量趋势。方法:采用等效剂量分析方法,比较2008—2017年总年人均用量及不同强阿片类药物年人均用量的趋势,并进一步分析短效与长效强阿片类药物的年人均用量差异。结果:近10年我院门诊强阿片类药物的年人均用量呈递增趋势,2017年为2008年的2. 11倍,其中长效制剂增长2. 21倍,短效制剂减少31%。羟考酮缓释片年人均用量逐年大幅增加,2017年羟考酮缓释片的人均用量最大,占总年人均用量的69. 79%;吗啡缓释片与吗啡片年人均用量趋势一致,表现为先增加后减少再趋于平稳;氨酚羟考酮片与芬太尼透皮贴剂的年人均用量均为逐年递增趋势。结论:2008—2017年我院门诊强阿片药物的使用趋于规范、合理。     

品管圈活动在提高癌痛患者阿片类药物正确服药执行率中的应用

目的 探讨品管圈(QCC)活动在提高癌痛患者阿片类药物正确服药执行率中的应用效果.方法 2018年10月15日在本科室(肿瘤内科)成立QCC小组,以提高癌痛患者阿片类药物正确服药执行率为活动主题,通过现况调查,设定目标值,制作柏拉图分析得出癌痛患者阿片类药物正确服药的执行率低的改善重点是知识缺乏、依从性差.结果...     

番泻叶颗粒剂治疗癌痛病人阿片类药物相关性便秘的临床疗效观察

目的 观察番泻叶颗粒剂治疗癌痛病人阿片类药物相关性便秘(OIC)的疗效.方法 选取患有OIC的癌痛病人120例,采用随机数字表法分为治疗组(番泻叶颗粒剂组)和对照组(乳果糖口服溶液组),分别采用番泻叶颗粒剂和乳果糖口服溶液治疗.根据肠功能指数(BFI)量表对病人便秘进行评分,比较两组病人治疗前、后的便秘评分和治疗疗效,并比较两组病人毒副反应的发生.结果 治疗组60例病人治疗便秘的总有效率为98.3%,对照组60例病人治疗便秘的总有效率为76.67%.秩和检验比较两组病人的治疗疗效,Z值为-3.82,P<0.05,差异有统计学意义.可认为番泻叶颗粒剂治疗癌痛病人OIC疗效高于乳果糖口服溶液.对两组病人治疗前、后便秘评分进行比较,治疗组治疗前、后的便秘评分分别为(68.78±13.18)分和(14.50±10.52)分,对结果进行t检验,差异有统计学意义(t=31.2,P<0.05).对照组治疗前、后的便秘评分分别为(69.89±12.07)分和(26.62±20.23)分.两组治疗前便秘评分差异无统计学意义(t=0.482,P=0.63),两组治疗后便秘评分差异有统计学意义(t=-4.12,P<0.05),治疗组在降低便秘评分上优于对照组.两组病人腹痛(Z=-1.96,P>0.05)、腹泻(Z=-1.97,P>0.05)以及呕吐(Z=-0.58,P>0.05)的发生比较,差异无统计学意义.结论 番泻叶颗粒剂能有效治疗阿片类药物相关性便秘,且毒副反应轻微.     

1例阿片耐受患者的癌痛用药分析

本文通过对1例晚期壶腹癌阿片耐受患者癌痛合并神经病理性疼痛治疗的病例介绍与分析,探索如何依据患者疼痛控制情况,调整止痛药物治疗方案,及时解决出现的问题,使患者有效控制疼痛,提高生活质量.     

The use of opioids for treatment of cancer pain

Introduction: Pain is commonly experienced by patients with cancer, particularly those with advanced disease. Alleviating pain is an important goal of cancer treatment. Opioids are the cornerstone of the analgesic treatment.

Areas covered: Pharmacology, characteristics, and use of opioids in clinical practice are presented.

Expert opinion: Although the use of opioids is largely accepted as a fundamental step for controlling cancer pain, existing data supporting this statement are poor. All opioids provide analgesia and are effective in controlling cancer pain. New drugs have been developed and experience is accumulating among clinicians. Despite these drugs having different pharmacokinetic and chemical properties, there is no proof that one opioid is better than another one. Thus, the optimum benefit depends on the experience of the users. Clinicians should weight evidence, clinical experience, patient preferences, and treatment costs when choosing the optimal treatment for an individual patient with cancer pain. New opioids with specific receptor activities are under investigation.     

我院癌痛住院患者阿片类药物的应用评价与分析

目的 通过对中西医结合医院住院癌痛患者阿片类药物用药情况进行分析评价,为临床合理使用阿片类药物提供参考。方法 查阅我院2013年1月至2014年12月癌痛住院患者的电子病历,对阿片类药物进行用药频度（DDDs）、药物利用指数（DUI）、癌痛分布、癌症患者出院疼痛评分和用药合理性进行评价。结果 在292例已填写癌痛评估表的治疗患者中,癌痛控制不佳的有89例,占30.48%;其余203例疼痛强度≤3。阿片类长效制剂枸橼酸舒芬太尼注射液及芬太尼衍生物类占据DDDs前列,为我院主要类型癌痛患者治疗的主要用药。临床部分科室存在不合理使用芬太尼透皮贴剂现象。结论 阿片类药物的使用基本符合要求,但尚存不足之处,仍需进一步加强对麻醉药品使用的干预和管理。     

弱阿片药物与低剂量强阿片药物治疗中度癌痛的Meta分析与GRADE评价

目的：评价弱阿片类药物（Weak Opioids,WO）与低剂量强阿片类药物（Low-Dose Strong Opioids,LDSO）治疗中度癌痛的有效性和安全性。方法：以"吗啡","羟考酮","曲马多","可待因","中度癌痛"为关键词对Pubmed、EMbase、Cochrane Library、中国知网、万方、维普等数据库进行检索。以临床疗效为主要结局、毒副反应（恶心呕吐,嗜睡,厌食和便秘）为次要结局,采用软件Review Manager 5.3对数据进行处理,并采用软件GRADE profiler 3.6对结果证据质量进行评级。结果：纳入4项随机对照研究,共计708例患者。结果表明LDSO对中度癌痛的控制要优于WO[OR=3.50,95% CI（2.39 to 5.13）,P<0.000 01]。而在毒副反应方面,两组的恶心呕吐[OR=0.92,95% CI（0.59 to 1.42）,P=0.69]、嗜睡[OR=1.23,95% CI（0.74 to 2.05）,P=0.42]、厌食[OR=1.19,95% CI（0.59 to 2.37）,P=0.63] 以及便秘[OR=1.34,95% CI（0.87 to 2.07）,P=0.19] 均无显著性差异。缓解率和各毒副反应的GRADE证据评价级均为中级。结论：在治疗中度癌痛中,LDSO的疗效优于WO,且耐受性良好,提示临床可以采用弱化二阶梯方案,将LDSO用于治疗中度癌痛。     

New drugs for pain management in advanced cancer patients

Introduction: Advanced cancer patients represent a frail population, often requiring aggressive pain management, particularly in the late stage of disease, when untreated pain is one the most important causes of suffering.

Areas covered: In the last decade, a series of new analgesics have been introduced in the market to offer additional options amongst existent drugs. The characteristics of these drugs, their efficacy and tolerability are examined on the basis of existent studies.

Expert opinion: Although new analgesic preparations have been developed in recent years, no specific drug has provided a better analgesic performance in comparison with others. Some technologies have been developed to increase the safety or decrease the opioid-related adverse effects, with some molecules providing extra-opioid analgesia. However, existing studies did not present relevant advantages over traditional opioids. The new formulations developed to provide a rapid and non-invasive analgesia for breakthrough pain have really changed the approach to this phenomenon, characterized by a specific temporal pattern requiring a short onset, and duration of the analgesic effect. The availability of new drugs, indeed, may enlarge the possibilities of individualizing treatment, according to specific clinical needs and individual response.     

临床药师参与癌痛伴肾功能不全患者止痛方案的实践与经验

目的 探讨临床药师在止痛治疗中的作用,促进镇痛药更加规范的使用。方法 临床药师通过参与癌痛伴肾功能不全患者止痛方案的制定,从药物的选择、给药剂量以及不良反应预计等方面,提出药学观点。结果 医师采用了临床药师的建议,首日使用盐酸吗啡片进行快速滴定,次日起使用羟考酮缓释片控制背景疼痛,小剂量盐酸吗啡片控制爆发痛,在疼痛控制稳定后,改用芬太尼贴剂以减轻肾功能损害。结论 临床药师参与到重度癌痛患者的治疗方案制定中,能提高患者用药安全性、合理性,提高临床治疗效果。     

Chronic pain management issues in the primary care setting and the utility of long-acting opioids

Importance of the field: Chronic/persistent pain – a highly prevalent condition that places a substantial burden on patients in terms of personal suffering, reduced productivity and health care costs – remains inadequately treated in many patients. The purpose of this review is to provide an overview and evaluate the burden and undertreatment of chronic/persistent pain, considerations for choosing an analgesic and the utility of long-acting opioids.

Areas covered in this review: A PubMed search was conducted to identify randomized, placebo-controlled trials evaluating the efficacy and safety of long-acting opioids in chronic pain conditions. The following search terms were used: long-acting opioids, extended-release opioids, controlled-release opioids, sustained-release opioids, and transdermal opioids. The search was limited to randomized, controlled trials published within the last 10 years (1998 – 2008). Studies meeting the following criteria were excluded from review: those focused on a neuropathic pain condition or specific patient subpopulations (e.g., opioid-experienced patients); those conducted outside the USA; and those evaluating a long-acting opioid that is not on the US market at present.

What the reader will gain: The reader will first develop a better understanding of the individual and societal ramifications of undertreated chronic pain. Then, a critical review of safety and efficacy data from well-controlled randomized studies will help readers understand the choices and variables that should be considered when selecting appropriate treatments for patients with chronic pain.

Take home message: Successful management of chronic/persistent pain should be individually tailored to each patient, taking into account his or her pain intensity and duration, disease state, tolerance of adverse events and risk of medication abuse or diversion. The literature supports the efficacy and safety of a number of long-acting opioids for the treatment of moderate to severe chronic pain, demonstrating sustained improvements in pain intensity and pain-related sleep disturbances with these agents.     

基因多态性对阿片类药物疼痛治疗影响的研究进展

目的:综述阿片类药物镇痛治疗相关基因组学的研究现状,为临床疼痛治疗提供参考。方法:查阅近年国内外有关文献,对已报道的有关阿片类药物镇痛治疗的基因组学及其相关研究进行总结和归纳。结果:阿片类药物镇痛治疗基因组学研究取得很大进展。因受药物代谢酶基因(如CYP3A4、CYP2D6、UGT、COMT)、药物作用靶点或受体基因(如OPRM1)、转运蛋白基因(如ABCB1)多态性的影响,阿片类药物镇痛治疗疗效和不良反应存在很大个体差异。以上相关基因的多态性与阿片类药物用于患者疼痛治疗的有效剂量、治疗效果以及不良反应的发生有密切关系。结论:开展相关基因检测,有助于提高阿片类药物疼痛治疗的精准性。     

Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

AIMS: Previous research has reported on reduced paw withdrawal latencies to heat and mechanical stimuli after parenteral administration of opioids in animals and on increased pain sensitivity in humans subsequent to postoperative infusions of short-acting opioids or in drug addicts. The aim of the present study was to explore the possibility that oral opioid treated patients with cancer-related or chronic nonmalignant pain differ in their pain sensitivity from patients treated with non-opioid analgesics. METHODS: The study population consisted of 224 patients, including 142 in the opioid-treated group and 82 in the non-opioid-treated group. Pain thresholds for punctuate measured by von Frey filaments (g), mechanical pressure measured by pressure algometer (mmHg), heat stimuli measured by quantitative sensory testing (degrees C), as well as suprathreshold tonic heat pain intensity (46.5 degrees C for 1 min) measured by 0-10 numerical pain scale (NPS) were obtained at a nonpainful site (thenar eminence) in all patients. RESULTS: No differences between the groups were found for gender, age, duration of pain, or duration of treatment (independent variables). No significant differences between the groups were found in punctuate (difference = 17.0 g (95% CI -8.8, 42.8), P = 0.19), pressure (2.2 mmHg (-28.7, 33.2), P = 0.89) and heat (-0.3 degrees C (-1.5, 0.9), P = 0.70) pain thresholds, or in suprathreshold heat pain intensity (difference between maximal pain intensities -0.4 NPS units (95% CI -1.2, 0.4), P = 0.31). Pearson correlations within the opioid-treated group failed to show significant relationships between any of the independent variables and the outcome measures. A further comparison of the outcomes between the 'weak' opioid-treated subgroup and the 'strong' opioid-treated subgroup again revealed insignificant results. CONCLUSIONS: These results suggest that the administration of 'commonly used' dosages of oral opioids does not result in abnormal pain sensitivity beyond that of patients receiving non-opioid analgesia.