经口服和直肠应用吗啡控释片对癌性疼痛疗效对比研究

目的 观察应用硫酸吗啡控释片(MST)口服和经直肠不同途径对中重度癌性疼痛的疗效和不良反应。方法 85例伴有中重度疼痛的癌症患者被随机分A组(口服MST)42例和B组(经直肠应用MST)43例。结果 A组患者维持剂量≤60mg／d和＞60mg／d的有效率分别86.8％,100％,而B组分别为89．2％,83．3％,两组无明显差异(P＞0．05);并且进一步对A、B两组不同疼痛分级,不同疼痛类型的止痛效果分析,均无明显差异(P＞0．05);另外A、B两组的不良反应如恶心、呕吐、便秘、头晕、嗜睡等均无统计学差异(P＞0．05)。结论 经口服和直肠应用MST的疗效和不良反应相近,经直肠应用MST是一种有效、安全、方便的镇痛方法之一。     

硫酸吗啡控释片直肠给药控制癌痛

目的：有效地控制中晚期癌痛患者的疼痛。方法：对临床25例因恶心、呕吐、吞咽困难、术后禁食无法口服给药的中晚期癌痛患者，采用硫酸玛啡控释片直肠给药方法用药。结果；有效地控制了癌痛。结论；硫酸吗啡控释片直肠给药安全、无创伤、便于操作、镇痛效果好。     

硫酸吗啡控释片治疗癌痛的临床疗效观察

目的观察硫酸吗啡控释片(美施康定)对晚期癌症疼痛患者的止痛效果和不良反应.方法选择100例应用第二阶梯止痛药不能缓解的中、重度癌痛患者,给予美施康定口服治疗,在用药后15天评价疼痛缓解率及不良反应.结果中度疼痛组镇痛后缓解率为91.8%,重度疼痛组缓解率为96.8%,总的疼痛缓解率为95%,副作用较轻,多为便秘、恶心呕吐及头晕等,未发现呼吸抑制及成瘾现象.结论美施康定具有使用方便、止痛效果确切、维持时间长、毒副作用小等优点,值得临床作为第三阶梯止痛药推广应用.     

硫酸吗啡控释片大剂量口服治疗癌痛一例报道

我科一晚期肿瘤患者口服硫酸吗啡控释片(美施康定)时间长达２０个月,最高剂量达到１２００ｍｇ．ｄ-１。现报道如下:患者,女,年龄４６ａ,身高１７０ｃｍ,体重５１ｋｇ,职业:护士。１９８９年７月初以右颌下肿块起病。８月９日在本市九院行“口底部癌根治术”,手术病理:右口底腺样囊性癌(筛状型)。术后化疗２次。９月１９日始在肿瘤医院放疗。此后病情稳定。１９９２年１月在上海胸科医院经胸片及ＣＴ检查证实癌肿两肺广泛转移,以右侧为主。１９９６年３月癌肿累及胸壁,１９９７年６月又累及膈肌和肋骨。其间先后在上海肿瘤医院和我院化疗…     

硫酸吗啡控释片直肠给药治疗癌痛的临床观察

痛是中晚期癌症病人常见的症状,严重影响了病人的生存质量。对多数癌症疼痛患者,一般非阿片类止痛药难以奏效。我院自1999年4月～1999年5月,应用硫酸吗啡控释片(美施康定,MST)分别采取直肠给药和口服给药观察其疗效和不良反应,现报告如下。     

硫酸吗啡控释片治疗癌痛体会

硫酸吗啡控释片为阿片类药物 ,治疗中晚期癌痛疗效显著 ,对 1997年以来 ,使用该药 80例患者的疗效及各种副反应进行回顾性分析 ,现报告如下。对象与方法一、对象 :80例患者 ,男性 5 1例 ,女性 2 9例。年龄 9～ 88岁 ,平均年龄 5 4 6岁。全部为中晚期癌症患者 ,其中肺癌 30例 ,乳腺癌、胃癌各 8例 ,结肠癌 7例 ,肝癌 5例 ,食管癌、胰腺癌各 4例 ,鼻咽癌、骨肉瘤、前列腺癌各 2例 ,肾癌、多发性骨髓瘤、淋巴瘤各 1例 ,不明原因骨转移癌 5例。疼痛程度 :重度疼痛 6 5例 ,中度疼痛 15例。疼痛类型包括 :骨痛、内脏痛、软组织浸润性痛、神经痛及…     

硫酸吗啡控释片直肠给药治疗晚期癌痛的Meta分析

目的:评价硫酸吗啡控释片直肠给药与口服给药治疗癌痛的疗效差异及安全性.方法:两名作者独立收集国内相关数据库文献资料,运用Meta分析方法对资料进行定量综合评价.结果:共有10篇文献,888例癌痛患者纳入分析,两种给药途径总有效率的差别无统计学意义[OR=1.15,95%CI(0.70,1.89),P=0.58];硫酸吗...     

硫酸吗啡控释片口服与直肠给药控制癌痛疗效观察

目的 观察硫酸吗啡控释片口服给药和直肠给药对重度癌性疼痛的止痛效果.方法 采用交叉研究的方法,将100例重度癌性疼痛患者随机分为A、B两组.A组先口服给药后直肠给药,B组先直肠给药后口服给药,各用5天,剂量为30mg每12h.结果 口服给药患者的总有效率90%,直肠给药患者的总有效率87%,止痛效果明确,但两者之间无显著性差异(P＞0.05).两组给药方法的不良反应相同,主要为头昏、嗜睡、恶心呕吐、腹胀、便秘、排尿困难.口服给药总的不良反应发生率为74%,直肠给药总的不良反应发生率为45%,两者之间有显著性差异(P＜0.05).结论 硫酸吗啡控释片经直肠给药对重度癌性疼痛的止痛效果与口服相近,不良反应少,适用于口服不良反应多和不能口服的患者.     

硫酸吗啡控释片治疗重度癌痛的个体化用药

癌症患者最令人恐惧的并发症是疼痛,疼痛仍是目前诊断、治疗过程中非常棘手的问题.有效控制癌痛,最大程度提高生活质量,是患者的权利,也是医师的职责.按照世界卫生组织(WHO)三阶梯止痛治疗原则进行癌痛的规范化治疗,目前绝大多数癌性疼痛患者的疼痛可得到较好缓解.     

疏酸吗啡控释片治疗重度癌痛的个体化用药

癌症患者最令人恐惧的并发症是疼痛，疼痛仍是目前诊断、治疗过程中非常棘手的问题。有效控制癌痛，最大程度提高生活质量，是患者的权利，也是医师的职责。按照世界卫生组织（WHO）三阶梯止痛治疗原则进行癌痛的规范化治疗，目前绝大多数癌性疼痛患者的疼痛可得到较好缓解。     

Comparison of TTS-fentanyl with sustained-release oral morphine in the treatment of patients not using opioids for mild-to-moderate pain

SUMMARY

Objective: This randomised, multicentre, direct open comparative trial evaluated the efficacy, treatment convenience, tolerability and safety aspects of transdermal therapeutic system (TTS)-fentanyl and sustained-release oral morphine (SRM) in both opioid-naïve patients with moderate-to-severe cancer-related pain and in patients who had already been using opioids for mild-to-moderate pain. The two treatment groups were run in parallel. Special attention was paid to constipation, nausea/vomiting, drowsiness and respiratory depression.

Patients and methods: The 131 enrolled patients started the 4-week treatment at low doses of opioid (25?μg/h TTS-fentanyl for 3 days or 30?mg SRM every 12?h) and were individually titrated. Tolerability, efficacy and safety were assessed throughout the study period. Frequency of constipation was the primary study variable and accordingly the study was powered for this. Both patients and investigators made a global treatment evaluation.

Results: TTS-fentanyl and SRM were shown to be equally effective. Pain control and sleep quality improved with both treatments. None of the patients developed respiratory depression. Statistically significantly more patients in the SRM treatment group discontinued the trial prematurely (59% vs 27%; p?<?0.001), particularly due to adverse events (36% vs 4%; p?<?0.001). Fewer patients in the TTS-fentanyl than in the SRM treatment group reported constipation during the trial. This finding was statistically significant after 1 week of treatment (27% vs 57%; p?=?0.003). The favourable tolerability profile of TTS-fentanyl was also reflected in both the patient and the investigator global evaluation of the treatment. Patient assessment favoured TTS-fentanyl treatment in terms of a significantly lower rate of troublesome side-effects (‘quite a bit’ to ‘very much’ troublesome side-effects in 14% vs 36% of patients; p?=?0.003) and less interruption of daily activities (absence of any interruption of daily activities in 88% vs 63% of patients; p?=?0.012). Investigators scored TTS-fentanyl as significantly better with respect to ‘side-effects’ (p?=?0.039) and ‘overall impression’ (p?=?0.013). Sub-analyses of opioid-naïve users gave similar results.

Conclusion: These data indicate that TTS-fentanyl, when used as an opioid of first choice in the treatment of cancer-related pain, is as effective as, but better tolerated than, SRM, including in opioid-naïve patients.     

硫酸吗啡控释片直肠给药治疗癌性疼痛临床观察

目的:观察硫酸吗啡控释片(美施康定)直肠给药治疗癌性疼痛的疗效、生活质量与毒副反应。方法:对入选的41例恶心、呕吐、梗阻、吞咽困难的癌痛患者予美施康定直肠给药每12h一次,对照组32例予美施康定口服给药每12h一次。结果:直肠给药组止痛总有效率97.56％,毒副反应发生率19.52％,Karnofsky评分由(45.24±8.21)提高到(66.22±11.6);口服治疗组止痛总有效率96.87％,毒副反应发生率56.24％,Karnofsky评分由(47.81±12.11)提高到(66.72±10.36)。两组在疗效及生活质量上无明显差异(P>0.05),毒副反应发生率有明显差异(P<0.01)。结论:美施康定直肠给药治疗癌性疼痛疗效肯定,毒副反应较轻,适用于无法口服治疗的病人。     

Relative potency of controlled-release oxycodone and controlled-release morphine in a postoperative pain model

Objective: The relative analgesic potency of single doses of oral controlled-release oxycodone and oral controlled-release morphine were compared in a randomized, double-blind trial using a postoperative pain model. Methods: Women (n = 169) with moderate to severe pain following abdominal hysterectomy received single oral doses of controlled-release oxycodone, 20 mg or 40 mg, or controlled-release morphine, 45 mg or 90 mg. Assessments were made at 30 min, 60 min, then hourly after dosing for 12 h or until remedication. Results: The most precise estimates of relative potency showed that controlled-release oxycodone was 1.8 times more potent than controlled-release morphine for total effect (95% confidence limits 1.09–2.42; lambda 0.44) and 2.2 times more potent for peak effect (95% confidence limits 0.96–4.59; lambda 0.71). Controlled-release oxycodone at doses of 20 mg or 40 mg was comparable with controlled-release morphine at doses of 45 mg or 90 mg, respectively, for total and peak analgesic effects. For the two higher doses, time to peak relief was approximately 1 h shorter with controlled-release oxycodone than with controlled-release morphine. Most patients reported onset of analgesia within 1 h with all doses. Side effects were similar with the two opioids. Conclusion: Oral controlled-release oxycodone was twice as potent as oral controlled-release morphine in this single-dose, relative potency assay. When converting patients from oral morphine to oral oxycodone, an initial oral oxycodone dose of one-half the oral morphine dose is recommended. Received: 10 August 1998 / Accepted in revised form: 9 March 1999     

氨酚羟考酮片与硫酸吗啡控释片治疗晚期中度或中重度癌痛患者的疗效与药物经济学分析

目的:探讨氨酚羟考酮片(泰勒宁)与硫酸吗啡控释片(美施康定)用于晚期癌痛患者镇痛治疗的疗效和获益成本分析.方法:选取泰勒宁口服治疗的52例患者和美施康定口服治疗的60例患者,比较用药4周后的镇痛疗效、不良反应以及应用药物经济学的费用效果分析法比较各组用药的成本.结果:泰勒宁组镇痛治疗的总有效率为80.8%,美施康定组为86.7%,两组间疗效无统计学差异(P＞0.05).泰勒宁使用后的不良反应发生率较低,美施康定治疗后便秘等消化道不良反应发生率较多见.两组疗效相当,但泰勒宁的成本/效果比(C/E)较低.结论:泰勒宁和美施康定用于中度或中重度癌痛患者镇痛治疗疗效相当,泰勒宁的治疗成本较低,美施康定治疗的不良反应较常见.     

口服吗啡缓释片与静脉自控镇痛对晚期癌性疼痛的临床疗效比较

目的：综合比较吗啡缓释片和病人自控静脉镇痛在晚期癌症病人疼痛治疗中的临床效果。方法：80例晚期癌症病人,随机分为2组,每组40例。吗啡缓释片组(M组)口服吗啡缓释片90～270mg／d,分2次给药;病人自控静脉镇痛组(PCIA组)的给药方式为“负荷量十背景量十病人自控给药量”模式,药液配方为枸橼酸芬太尼3mg,氟哌利多5mg,添加生理盐水至100ml。比较两组镇痛效果、治疗费用、病人满意率、不良反应发生率。结果：两组日均用药量基本等效。PCIA组镇痛效果较好,镇静程度较低,不良反应发生率低,病人满意率高。结论：PCIA在晚期癌症镇痛治疗中优点明显。安全性较高。     

硫酸吗啡与盐酸吗啡普通片对照治疗中、重度癌痛84例

目的:评价硫酸吗啡与盐酸吗啡普通片对癌症疼痛的镇痛疗效及不良反应.方法:采用多中心随机对照试验,试验组(n=44)用硫酸吗啡,对照组(n=40)用盐酸吗啡,起始量均为10～30mg,每4～6h用1次,进行个体剂量滴定,达到无痛或基本无痛的维持量继续应用,共7d.结果:2组的疼痛完全缓解率分别为77.3%与77.5%,显著缓解率为95.5%与97.5%,总有效率为100%.结论:硫酸吗啡与盐酸吗啡片治疗中、重度癌痛均有显著疗效.     

硫酸吗啡控释片直肠给药缓解晚期癌痛的临床观察

目的探讨硫酸吗啡控释片口服或直肠给药对晚期癌痛的止痛效果及不良反应。方法将70例中、重度疼痛晚期癌症患者随机分为口服给药组和直肠用药组,各35例。分别采用硫酸吗啡控释片口服或直肠给药,观察其疗效及不良反应。结果药物的起效时间、镇痛时间存在个体差异。口服给药组总有效率为91．4％高于直肠用药组的88．6％,差异无统计学意义（P〉0．05）。结论硫酸吗啡控释片直肠给药是一种有效、安全的镇痛途径。     

重视吗啡治疗癌痛病人的个体差异

吗啡是癌痛治疗的首选药物,经过20余年的努力,全球吗啡的消耗量得到快速增长,我国也不例外。然而我国癌症病人中70%以上仍在疼痛,近一半的病人忍受着重度疼痛的折磨。本文从三个方面分析了癌痛病人未得到足够止痛的主要原因：一是药物的剂量不足或副作用处置不当;二是病人或病人家属对阿片类药物的＂成瘾性＂过度担心;三是药品供应与管理上过分强调严格。临床医师、药师应不断加强业务知识的更新,多方协作、共同努力,不断开拓新思路,树立为病人解除疼痛折磨的观点,规范应用有效的治疗药品,真正做到为癌痛病人解除疼痛的折磨而尽心尽力。     

Management of cancer pain with oral controlled-release morphine sulfate

Morphine sulfate Contin (MSC) is an investigational matrix delivery system for oral morphine sulfate that allows for prolonged blood levels of morphine. Twenty-six patients with inadequately controlled cancer-related pain were examined in an open but controlled study using MSC. Initially, all patients were converted from the prestudy analgesic regimen to an equianalgesic amount of immediate-release morphine sulfate (IRMS) on a q4h dose schedule that was in turn titrated to the level of adequate pain relief. Patients then were switched to MSC q8h and eventually to q12h, starting at doses representing the same total daily amount of morphine that was in the final IRMS dose. Of the 18 patients who completed the study, all achieved satisfactory levels of analgesia on MSC, seven at q8h and 11 at q12h dosing intervals. All patients reported better analgesia while taking MSC compared with their previous regimen. Side effects associated with MSC included sedation and constipation but not nausea or respiratory difficulty. Significant drug tolerance did not develop during a mean follow-up period of four weeks (range, 1-18 weeks). MSC is an effective oral opioid analgesic that allows an increased dose interval without increased side effects or decreased potency. It can improve the quality of life of cancer patients by allowing them to be maintained without frequent dosing or parenteral medication.     

Meta-analysis of the clinical efficacy and safety of oxycodone and morphine in cancer pain treatment

In the present study, the efficacy and safety of oxycodone and morphine in the treatment of cancer pain were compared in a meta-analysis with the goal of providing a reference for drug selection in clinical practice. Electronic literature databases were searched for articles published through February 2015, including PubMed, MEDLINE, the Cochrane library, and Embase; and the China National Knowledge Internet, VIP Databases and Wanfang Databases for studies published in Chinese. Only randomized controlled trials were selected. The primary outcome measures were efficacy and the incidence of adverse drug reactions (ADRs). Data were extracted from the studies by two independent reviewers. A total of 15 studies containing 1338 patients were included in the analysis. The studies were divided into two subgroups according to different scoring methods. The pain relief efficacies of oxycodone and morphine were rated by the numerical rating scale (NRS) (risk ratio [RR]: 1.04; 95% confidence interval [CI]: 0.97–1.11). Others were rated by the visual analog scale (VAS) (RR: 1.03; 95% CI: 0.97–1.10). Five studies showed that pain intensity scores did notsignificantly differ between oxycodone and morphine treatments (standard mean difference [SMD] = 0.16, 95% CI: –0.01~0.33, P = 0.06). Regarding ADRs, the incidence of constipation was lower in the oxycodone group (RR: 0.70; 95% CI: 0.58–0.85). No statistical difference was observed among other ADRs. The efficacies of oxycodone and morphine were similar in treating cancer pain. However, the incidence of constipation was lower in patients treated with oxycodone.