硫酸吗啡控释剂直肠给药对癌痛的疗效观察

目的观察硫酸吗啡控释剂（美施康定）直肠给药的临床疗效与不良反应。方法选择92例中、重度癌性疼痛的男性患者,随机分为口服组和直肠给药组,初给剂量为10 mg,根据疼痛逐渐增加剂量,记录治疗前、后的疼痛强度、生活质量和用药不良反应。结果美施康定使用后口服组Ⅱ度疼痛缓解率43.5%（20/46例）,Ⅲ度缓解率39.1%（18/46例）,Ⅳ度缓解率8.7%（4/46例）;直肠组Ⅱ度疼痛缓解率34.8%（16/46例）,Ⅲ度缓解率28.3%（13/46例）,Ⅳ度缓解率6.5% （3/46例）。口服给药与直肠给药疼痛缓解率差异有统计学意义（P〈0.01）。不良反应口服组便秘者占60.9%（28/46例）,排尿困难者占65.2%（30/46例）;直肠组便秘者占10.7%（5/46例）,排尿困难者占2.2%（1/46例）,不良反应有统计学差异（P〈0.01）。结论美施康定直肠给药的镇痛效果虽不及口服给药,但可明显减轻胃肠反应及排尿困难,亦能改善癌痛患者的生活质量,尤其适用于前列腺肥大及不能口服用药的患者。

Effects of rectal controlled release morphine sulfate on cancer pain

Objective To observe the effects and side effects of controlled release morphine sulfate （MS Contin） per rectum on the advanced cancer pain. Methods Ninety two male patients with severe cancer pain were divided into two groups randomly,oral and rectal group. The first dose was 10 mg and the dose were adjusted according to the pain intensity later. The pain intensity,life quality and side effects before and after MS Contin administered were recorded. Results The remission rate of oral group in Ⅱ degree, Ⅲ degree,Ⅳ degree were 43.5% （20/46 cases ）, 39.1% （ 18/ 46 eases ） and 8.7% （4/46 cases） respectively,which were statistically significant compared with the ractal group （P 〈 0.01 ）. Side effects including constipation （ 60. 9%） （ 28/46 cases） and dysuria （65.2%）（30/46 cases） in oral group were higher than that in ractal group（P〈0.01） in which constipation 10.7% （5/46 cases ） and dysuria 2.2% （1/46 cases） . Conclusion MS Contin given by rectum have a low gastrointestinal and dysuria side reaction and high quality of life, although the analgesic effects is not superior to per os.