芬太尼透皮贴剂治疗中重度癌痛疗效观察

目的：观察芬太尼透皮贴剂治疗中重度癌痛镇痛效果及不良反应（ADR）。方法：47例中重度癌痛患者随机分为2组,分别应用芬太尼透皮贴剂（24例,A组）和硫酸吗啡缓释片（23例,B组）进行治疗。所有病例均观察至少15d,比较两组的疼痛强度、疼痛缓解度及不良反应发生率。结果：A组和B组3度以上疼痛缓解率分别为83．33％和78．26％（P〉0．05）;A组恶心、呕吐、便秘的发生率低于B组（P〈0．05）。结论：芬太尼透皮贴剂可有效地控制中重度癌痛,且恶心、呕吐、便秘的发生率更低。     

芬太尼透皮贴剂治疗中重度癌痛的临床观察

目的：探讨芬太尼透皮贴剂治疗中重度癌痛的疗效及安全性。方法：通过对31例癌痛患者接受芬太尼透皮贴剂止痛治疗的临床疗效进行观察，以视觉模拟评分法评估疼痛程度，生活质量和不良反应。结果：治疗前疼痛程度评分均值为8．6，治疗后7天、14天疼痛程度评分分别降至2．5及2．1，疼痛程度显著减轻，总有效率为93．3％；患者治疗后生活质量明显改善，P〈0．05。不良反应主要是恶心、呕吐、不适、头晕、皮肤搔痒，但程度轻微，予以对症治疗后均可控制。结论：芬太尼透皮贴剂治疗癌痛安全有效，满意度高。     

芬太尼透皮贴剂治疗中重度癌性疼痛的临床观察

目的:观察芬太尼透皮贴剂对中晚期癌症镇痛的效果。方法:对120例具有中重度癌痛患者进行治疗。初治病人最初剂量为25μg·h-1;对以前曾用过强阿片类药物的患者根据病人用药情况进行芬太尼透皮贴剂剂量转换。结果:本组患者总缓解率95.0%(114/120),其中完全缓解率为80.0%(96/120),中度和明显缓解率为15.0%(18/120)。结论:芬太尼透皮贴剂治疗中重度癌性疼痛疗效确切,可作为口服强阿片类药物外的替代治疗,现已应用于临床。     

芬太尼透皮贴剂治疗中重度癌痛的疗效观察

目的 观察芬太尼透皮贴剂治疗中重度癌痛的临床疗效.方法 对86例患者给予芬太尼透皮贴剂治疗,起始剂量2.5mg,根据疼痛变化调整剂量,直到疼痛基本缓解.结果 治疗前患者疼痛程度评分为8.42±1.46,治疗后为1.84±1.16,治疗后疼痛程度显著减轻(P＜0.01),总有效率91.86%;治疗后患者的生活质量明显改善,治疗前后Karnofsky评分比较有显著性差异(P＜0.05),副作用少且轻微.结论 芬太尼透皮贴可有效控癌性疼痛,副作用少,值得临床推广应用.     

芬太尼透皮贴剂治疗中重度癌性疼痛的临床观察

目的：观察芬太尼透皮贴剂治疗中重度癌性疼痛的疗效及不良反应。方法：对56例中重度癌痛的患者使用芬太尼透皮贴剂治疗,初治患者最初剂量中度疼痛从25μg.h^-1开始使用,重度疼痛可从25μg.h^-1开始,随着患者的反应逐步提高剂量。曾用过强阿片类药物的患者则根据患者用药情况进行剂量转换[芬太尼透皮贴剂的剂量（μg.h-1,q72.h^-1）=口服吗啡的剂量（mg.d^-1）×1/2]。用药后根据患者疼痛缓解情况剂量调整,按照25μg.h^-1剂量增加,直至疼痛缓解。用药期间严密观察药物剂量的调整、疗效、耐受性、药物依赖性、不良反应等。结果：全组患者完全缓解43例（76.8%）、部分缓解9例（16.1%）,总缓解率92.9%（52/56）。主要的不良反应是便秘,头晕、恶心、呕吐、皮肤瘙痒等,发生率很低。结论：芬太尼透皮贴剂治疗中重度癌性疼痛疗效确切,不良反应轻微,耐受性好,可作为口服强阿片类药物外的替代治疗,尤其适用于不能口服止痛药的患者。     

芬太尼透皮贴剂治疗肺癌骨转移疼痛68例临床观察

芬太尼透皮贴剂（商品名：多瑞吉）是一种阿片受体激动剂，新型强效麻醉性镇痛药。其主要特点是通过皮肤吸收药物进而发挥疗效，是一种无创性治疗癌痛的新方法。它作为第三阶梯止痛药物对癌症患者疼痛的镇痛作用曾有报道，但对肺癌骨转移疼痛的治疗未有所闻。因此，我们从2000年10月至2004年9月对68例肺癌骨转移癌痛患者使用芬太尼透皮贴剂治疗，现将效果予以报告。     

复方苦参注射液联合芬太尼透皮贴剂治疗老年食管癌患者疼痛的疗效观察

目的观察复方苦参注射液联合芬太尼透皮贴剂治疗老年食管癌疼痛的疗效和不良反应。方法选取60例老年食管癌疼痛的患者,以随机抽样法分为治疗组(30例)和对照组(30例),治疗组给予复方苦参注射液联合芬太尼透皮贴剂治疗,对照组单用芬太尼透皮贴治疗,观察两组治疗前后的疗效及不良反应。结果治疗组总缓解率为90.0%,对照组总缓解率为66.7%,两组总缓解率比较有统计学差异(P<0.05);治疗组第7、14d疼痛数字评分法评分分别为为(2.5±0.3)和(2.1±0.5)分,治疗组第7、14d疼痛数字评分法评分分别为为(2.7±0.2)和(2.4±0.3)分,两组第7、14d疼痛数字评分有显著的统计学差异。结论复方苦参注射液联合芬太尼透皮贴剂治疗老年食管癌患者疼痛疗效显著,能够明显改善患者的生活质量。     

芬太尼透皮贴剂治疗癌性疼痛38例

目的评价芬太尼透皮贴剂治疗中、重度癌痛的疗效及安全性。方法中、重度癌痛患者38例，给予芬太尼透皮贴剂2.5～7.5 mg，外贴，每72 h更换1次，治疗6周。观察使用前后疼痛强度及用药后的不良反应。结果疼痛缓解有效率94.7%(36/38)，其中完全缓解10例（26.3%），明显缓解12例（31.6%），中度缓解14例（36.8%）;不良反应轻，主要为恶心、呕吐、便秘、头晕、嗜睡等。结论芬太尼透皮贴剂治疗中、重度癌痛疗效显著，不良反应轻，使用方便。     

芬太尼透皮贴剂治疗37例中重度晚期癌痛疗效观察

目的观察合并中重度疼痛癌症患者使用芬太尼透皮贴剂(多瑞吉)的镇痛效果及不良反应。方法采用多中心开放式研究，37例中重度癌痛患者使用芬太尼透皮贴剂治疗，观察并记录疼痛变化，生活质量改善情况，不良反应等。结果使用芬太尼透皮贴剂后疼痛完全缓解率37．84％，明显缓解率51．35％，轻度缓解率8．11%，未缓解率3．23％，不良反应主要为：头晕、恶心及呕吐、便秘、嗜睡、排尿困难、局部皮肤瘙痒等。结论芬太尼透皮贴剂治疗癌痛效果良好，毒副作用轻微，使用方便。     

芬太尼透皮贴剂治疗中重度癌痛53例临床观察

芬太尼透皮贴剂(多瑞吉)是一种经皮肤给药阿片类镇痛药,持续时间可达72小时。我们从2001年4月至2004年6月用其治疗中重度癌痛患者53例,现报告如下:材料和方法53例患者,其中男性31例、女性22例;年龄32~75岁,中位年龄55岁。肺癌25例,乳腺癌12例,大肠癌3例,原发性肝癌13例。以上病     

Low doses of transdermal fentanyl in opioid-naive patients with cancer pain

Abstract

Objective:

The aim of this study was to evaluate the effect and tolerability of low doses of transdermal (TD) fentanyl patches in opioid-naive patients with cancer pain.     

Use of transdermal fentanyl without prior opioid stabilization in patients with cancer pain

OBJECTIVE: To determine the safety and efficacy of transdermal fentanyl for pain relief in cancer patients and to compare the effects on patients according to whether they had previously received strong opioids, weak opioids or non-opioid analgesia. METHODS: Cancer patients requiring strong analgesia were recruited into an open-label, multicentre study, conducted in eight countries. Patients received transdermal fentanyl treatment for 28 days. Pain severity, overall satisfaction with pain control, convenience of use of patches and treatment preferences were recorded daily. RESULTS: Of the 292 participants, 135 had previously received a strong opioid, 84 had previously received a weak opioid and 73 had received no regular opioids. Thirty-eight patients did not complete the study, mainly due to adverse events. For all groups the proportion of patients with 'good to excellent' pain control increased after transdermal fentanyl treatment. Transdermal fentanyl was well tolerated, with the most common treatment-related adverse events being nausea, vomiting and constipation. The percentage of strong-opioid-tolerant patients with constipation decreased following transdermal fentanyl treatment and increased slightly in the strong-opioid-na?ve groups. Most patients rated the convenience of the patches as 'good to excellent', and most preferred transdermal fentanyl to their previous therapy. CONCLUSIONS: Transdermal fentanyl is an effective and well-tolerated treatment for cancer-related pain for patients regardless of whether they have previously received opioids. Previous guidelines have often advocated initial dose finding with short-acting opioids but this study demonstrates that such a complex titration and conversion schedule may not be necessary,and that treatment may be initiated directly with long-acting formulations such as transdermal fentanyl when previous analgesic therapy fails to provide adequate relief.     

Use of transdermal fentanyl without prior opioid stabilization in patients with cancer pain

SUMMARY

Objective: To determine the safety and efficacy of transdermal fentanyl for pain relief in cancer patients and to compare the effects on patients according to whether they had previously received strong opioids, weak opioids or non-opioid analgesia.

Methods: Cancer patients requiring strong analgesia were recruited into an open-label, multicentre study, conducted in eight countries. Patients received transdermal fentanyl treatment for 28days. Pain severity, overall satisfaction with pain control, convenience of use of patches and treatment preferences were recorded daily.

Results: Of the 292 participants, 135 had previously received a strong opioid, 84 had previously received a weak opioid and 73 had received no regular opioids. Thirty-eight patients did not complete the study, mainly due to adverse events. For all groups the proportion of patients with ‘good to excellent’ pain control increased after transdermal fentanyl treatment. Transdermal fentanyl was well tolerated, with the most common treatment-related adverse events being nausea, vomiting and constipation. The percentage of strong-opioid-tolerant patients with constipation decreased following transdermal fentanyl treatment and increased slightly in the strong-opioid-naïve groups. Most patients rated the convenience of the patches as ‘good to excellent’, and most preferred transdermal fentanyl to their previous therapy.

Conclusions: Transdermal fentanyl is an effective and well-tolerated treatment for cancer-related pain for patients regardless of whether they have previously received opioids. Previous guidelines have often advocated initial dose finding with short-acting opioids but this study demonstrates that such a complex titration and conversion schedule may not be necessary, and that treatment may be initiated directly with long-acting formulations such as transdermal fentanyl when previous analgesic therapy fails to provide adequate relief.     

芬太尼透皮贴剂用于禁食癌痛病人的疗效观察

绝大多数癌症病人在疾病的过程中都会出现疼痛.疼痛不仅发生在晚期癌症病人,早期病人也可以有疼痛,或以疼痛为首发症状[1].因此,控制疼痛也是癌症治疗的一个重要组成部分.目前临床上治疗疼痛最常用的药物为口服吗啡缓释片,而对禁食癌痛病人则大大地限制了该药的临床应用,哌替啶(商品名度冷丁)等注射止痛药作用时间短(一般为4 h)且成瘾性强.强效阿片类镇痛药芬太尼贴剂则较好地解决了这一难题,将其贴在病人皮肤上就能使药物缓慢地释放入血,并维持72 h恒定的血药浓度,且不良反应及成瘾性小.为了更好地了解芬太尼贴剂用于禁食癌痛病人的疗效和不良反应,我们对20例禁食癌痛病人进行了临床观察.     

芬太尼透皮贴剂与吗啡控释片治疗癌痛的临床观察

目的观察芬太尼透皮贴剂(多瑞吉)与吗啡控释片治疗癌痛病人的镇痛效果及副作用。方法 120例癌症疼痛病人随机分为3组,每组40例。组Ⅰ使用芬太尼透皮贴剂25μg/h,每72h一次。组Ⅱ口服硫酸吗啡控释片 (美施康)30mg,每12h一次。组Ⅲ口服盐酸吗啡控释片(美菲康)30mg,每12h一次。3组均为晚期癌症病人,且伴有中到重度疼痛。观察7-30d的镇痛效果及副作用。结果观察3组患者的疼痛缓解程度,达到完全缓解和明显缓解的均在90％以上,详见表1。说明3种方法均有明显的止痛疗效。3组患者的副作用见表2。其中组Ⅰ患者的嗜睡、恶心、呕吐及便秘的发生率低于其他两组。同时,我们观察到对于某些由于多种因素引起的“难治性疼痛”的患者,在使用芬太尼透皮贴剂的同时,配合使用其他吗啡制剂或一些侵入性方法(如神经阻滞和椎管内用药等),能取得较为满意的止痛疗效。结论芬太尼透皮贴剂治疗癌痛具有副作用小、使用方便和作用持久的特点。对于某些“难治性疼痛”的癌痛患者,应配合应用其他的止痛方法。     

A study of transdermal fentanyl in cancer pain at Aichi-Cancer Center

In Japan, transdermal fentanyl (Durotep Patch) was launched in March 2002, and it was regarded as making opioid rotation possible. When changing from morphine to transdermal fentanyl, the efficacy ratio of 1:150 is used in Japan as well as in many other countries. However, the ratio of 1:100 is used in Germany. As a result, a dose increase in transdermal fentanyl is often required to control pain. We studied transdermal fentanyl use in the Aichi Cancer Center (ACC) to investigate the actual conversion ratio and appropriate switching by following up 144 patients (81 men, 63 women) who had received transdermal fentanyl in the ACC from March 19, 2002, to April 30, 2003. Transdermal fentanyl improved pain control in patients who had difficulty in tolerating oral medication or in continuing morphine because of side effects. Regression analysis indicated that the efficacy ratio of oral morphine to transdermal fentanyl was 1:78. As the fentanyl dosage was excessive even in some patients who followed the recommended morphine/fentanyl conversion of 150:1, it is dangerous to use the conversion ratio of 78:1 at first. Morphine side effects were reduced in some patients who changed to transdermal fentanyl, but there was no reduction in those who needed high-dose morphine for rescue analgesia. Therefore it is safe and effective to use low-dose transdermal fentanyl in the beginning and to control pain promptly using rescue morphine based on the present recommended dosage. For opioid rotation, quick-acting opioids other than morphine are expected to be launched in Japan.     

曲马多复合芬太尼用于食管癌术后止痛临床观察

目的选择一种用于食管癌安全且有效的静脉术后止痛方法。方法随机选取60例食管癌患者分为两组。T组（曲马多0.3mg·kg^-·h^-＋芬太尼0.25mg·kg^-·h^-）,M组（吗啡0.014mg·kg^-·h^-）。比较VAS及不良反应。结果两组患者在术后72h中VAS评分基本为良好,止痛效果均较好,P〉0.05,无显著性差异;其中恶心、呼吸抑制及低血压这三种副反应的发生率也无显著性差异,P〉0.05;皮肤瘙痒、尿潴留和呕吐等不良反应在M组比T组要显著增多,P〈0.05,其发生率在M组依次为23.33%、23.33%和30%,在T组依次为0、6.67%和13.33%。结论曲马多配伍芬太尼用于食管癌手术后止痛是安全和有效的。     

胸腔镜下肺癌根治术患者疗效及安全性

目的对肺癌患者实施胸腔镜下根治手术,针对其临床效果及其安全性进行观察。方法选取漯河市中心医院接受治疗的患者作为研究对象,根据手术方式不同分为观察组（35例）和对照组（32例）,对两组患者术中指标、术后并发症以及随访半年后手术复发率进行比较分析。结果两组患者术中出血量、平均住院时间以及术后拔引流管时间,观察组少于对照组（P〈0．05）;观察组并发症的发生率（5．71％）明显低于对照组（28．12％）;随访半年后手术的复发率观察组为8．57％,对照组21．88％（P〈0．05）。结论对肺癌患者在情况允许的情况下采用胸腔镜下根治手术,具有创伤小,临床疗效好,术后并发症以及复发率低的特点。     

Efficacy and safety of transdermal fentanyl and sustained-release oral morphine in patients with cancer and chronic non-cancer pain

PURPOSE: To evaluate effectiveness and safety information of transdermal fentanyl (TDF) (Duragesic/Durogesic) and sustained-release oral morphine (SRM) in cancer pain (CP) and chronic non-cancer pain (NCP), a pooled analysis was conducted on datasets of published, open label, uncontrolled (no comparator group) and randomised controlled (with SRM as comparator) studies of TDF. PATIENTS AND METHODS: Eight trials with treatment durations of at least 28 days met the inclusion criteria. The effectiveness analysis assessed changes in average pain and pain 'right now' scores between baseline and Day 28. The safety analysis evaluated the incidence of adverse events (AEs) reported within the first 28 days of treatment with TDF or SRM. Subgroup analyses included pain type, gender, age, weight, and body mass index. RESULTS: Pooled efficacy data were available from 1220 patients; these showed that both TDF and SRM were effective in improving pain 'right now' scores (0-100 scale) from baseline to Day 28. The improvement was significantly more pronounced in the TDF treatment group (-26.7 +/- 31.3 for TDF, -18.7 +/- 30.9 for SRM, p = 0.002). This favourable effect of TDF was most apparent amongst patients with NCP. Data concerning AEs were available from over 2500 patients with CP (3 out of 10 patients) or chronic NCP (7 out of 10 patients). Significantly fewer patients in the TDF than in the SRM group reported any AE (72% vs. 87% respectively; p < 0.001), or an AE leading to the study drug being permanently discontinued (16% vs. 23% respectively; p < 0.001). Constipation and somnolence occurred considerably less frequently in the TDF than in the SRM treatment group. This difference was statistically significant in both the CP and NCP subgroups. CONCLUSION: This pooled data analysis provides expanded insight into the safety and effectiveness profile of transdermal fentanyl in patients with chronic pain. It shows significantly improved pain relief with transdermal fentanyl compared with sustained-release oral morphine, and supports current evidence of favourable tolerability of transdermal fentanyl, particularly with regard to reduced constipation and somnolence.