出院患者使用强阿片类镇痛药物的随访分析

目的：了解我院中重度疼痛患者出院后使用强阿片类镇痛药物的依从性和不良反应。方法：采集我院2020年 8月-9月出院开具强阿片类镇痛药品（硫酸吗啡缓释片,规格30mg、10mg;盐酸羟考酮缓释片,规格40mg、10mg;芬太尼透皮贴剂,规格4.2mg、2.5mg、4.125mg）的患者信息,并对患者进行电话随访,比较各组临床资料及随访数据差异。结果：总计获得291例疼痛患者出院带药数据。三种强阿片类镇痛药物在患者个人一般情况、电话应答率、疼痛类型、合并使用其他镇痛药比例等方面存在显著差异。吗啡缓释片组存在用药顾虑的患者比例最高,为18.4%,显著高于另外两组（P＜0.001）。吗啡缓释片组、羟考酮缓释片组及芬太尼透皮贴剂组不良反应发生率分别为45.65%、24.14%及14.29%,差异有统计学意义(P=0.001)。三组药物在用药依从性和疼痛控制效果方面无明显差异。结论：疼痛的处理除了遵守“WHO三阶梯止痛应用原则”选择合适的镇痛药物控制疼痛外,还和患者个人生活习惯、规范用药和正确药物认知存在必然联系,药师应积极转变药学服务模式,指导服务覆盖出院后患者,促进合理、规范、有效地使用医生开具的镇痛药物,缓解疼痛的同时,减少和避免不良反应,提高患者生存质量。

Follow-up analysis of the use of strong opioid analgesics in discharged patients

OBJECTIVE: To understand the norms and adverse reactions of opioid analgesics utilization in patients with moderate and severe pain after discharge from our hospital. METHOD: The study collected the medical records of discharged patients who were prescribed opioid analgesics (morphine sulfate sustained release tablets, strength 30mg, 10mg; oxycodone hydrochloride sustained release tablets, strength 40mg, 10mg; fentanyl transdermal patches, strength 4.2mg, 2.5mg, 4.125mg) from August 2020 to October 2020. All the patients were followed up by telephone. The differences in clinical data and follow-up results of each group were analyzed. RESULTS: The medical recordings of 291 patients discharged from our hospital were obtained. Among the three different opioid analgesics group, there were significant differences in the general condition of patients, telephone response rate, type of pain, and the proportion of combined use of other analgesics. The morphine sustained-release tablet group had the highest proportion of patients with medication concerns, which was 18.4% and was significantly higher than the other two groups (P<0.001). The incidence of adverse reactions in the morphine sustained-release tablet group, oxycodone sustained-release tablet group and fentanyl transdermal patch group were 45.65%, 24.14% and 14.29%, and the differences were statistically significant (P=0.001). The three groups had no significant differences in medication compliance and pain control effects. CONCLUSION: In addition to selecting appropriate analgesics by complying with the "WHO three-step analgesic application principle", pain management is also related to the patient''s personal living habits, standardized medication, and correct drug awareness. Pharmacists should actively involve in changing the service model, providing the guidance service after patients being discharged, and promoting the rational, standardized, and effective use of analgesics prescribed by doctors. Pharmacists should help patients to relieve pain, while reducing adverse reactions and improving the quality of life.