癌痛患者的不同滴定策略对比分析

目的 观察中重度癌痛治疗中不同滴定策略的效果，为临床中重度癌痛患者选择较优滴定方案。方法 选取我院2014年12月~2017年6月接受治疗的120例中重度癌痛患者，随机分为A组、B组和C组，每组40例。A组患者使用即释吗啡片5 mg q4h作为初始剂量滴定治疗；B组、C组患者分别使用盐酸吗啡缓释片10 mg、20 mg q12h作为初始剂量治疗。各组滴定至显效后即改为足量盐酸吗啡缓释片维持治疗。观察三组滴定显效时间、用药依从性、主要不良反应及平均初始日费用。结果 给药后A、B、C三组滴定显效时间分别为（1.53±0.96） d、（4.13±1.71）d和（2.76±0.81）d，差异有统计学意义（P＜0.05）。A、B、C三组患者的用药依从性分别为35.00%、90.00%和60.00%，差异有统计学意义（P＜0.05）。主要不良反应表现:B组便秘发生率为13.00%，低于A组的20.00%和C组的53.00%，差异有统计学意义（P＜0.05）；B组头晕发生率为3.00%，低于A组的23.00%和C组的28.00%，差异有统计学意义（P＜0.05）。A、B、C三组平均初始日费用分别为（39.5±17.13）元、（55.25±27.43）元和（65.13±27.07）元，差异有统计学意义（P＜0.05）。结论 以10 mg盐酸吗啡缓释片为初始剂量治疗中、重度癌痛患者显效时间稍长，但具有良好的用药依从性，不良反应较轻，容易管理，价格适中，是基层医院首选的滴定药物之一。

Comparative Analysis of Different Titration Strategies for Patients with Cancer Pain

Objective To observe the effect of different titration strategies in the treatment of moderate to severe cancer pain, and to select a better titration scheme for patients with severe cancer pain in the clinic. Methods A total of 120 patients with moderate to severe cancer pain who were treated in our hospital from December 2014 to June 2017 were randomly divided into group A, group B and group C, with 40 cases in each group. Patients in group A were treated with immediate release morphine tablets 5 mg q4h as initial dose titration; patients in group B and C were treated with morphine hydrochloride sustained release tablets 10 mg and 20 mg q12h as initial doses. After titration to significant effect, each group was changed to a sufficient amount of morphine hydrochloride sustained-release tablets for maintenance treatment. Three groups of titration time, medication compliance, major adverse reactions, and average initial day cost were observed. Results The effective time of titration in group A, B and C was (1.53±0.96) d, (4.13±1.71) d and (2.76±0.81) d, respectively,the difference was statistically significant (P<0.05). The medication compliance of the three groups A, B, and C were 35.00%, 90.00%, and 60.00%, respectively,the difference was statistically significant (P<0.05). The main adverse reactions: the incidence of constipation in group B was 13.00%, which was lower than 20.00% in group A and 53.00% in group C,the difference was statistically significant (P<0.05). The incidence of dizziness in group B was 3.00%,Less than 23.00% in Group A and 28.00% in group C, the difference was statistically significant (P<0.05). The average initial daily expenses of the three groups A, B and C were (39.5±17.13) yuan, (55.25±27.43) yuan and (65.13±27.07) yuan, the difference was statistically significant (P<0.05). Conclusion The 10 mg morphine hydrochloride sustained-release tablets as the initial dose for the treatment of patients with moderate to severe cancer pain has a slightly longer time, but has good medication compliance, mild adverse reactions, easy management, and moderate price. It is one of the preferred titration drugs for primary hospitals.