阿片转换在吗啡不耐受的癌痛患者的临床研究

目的 旨在前瞻性地评估晚期癌痛患者对吗啡敏感的个体差异及转换应用另一种阿片类药物止痛治疗的需要、临床获益与不良反应.方法 对238例使用口服吗啡的中重度癌痛患者进行评估,是否存在吗啡不耐受.将评估为吗啡不耐受的60例患者随机分为两组:转换应用口服羟考酮(羟考酮组)或芬太尼透皮贴剂(芬太尼组)各30例.阿片转换10 d后采用疼痛强度数字评分量表评价临床疗效,并比较羟考酮和芬太尼两组的临床疗效与不良反应.结果 发现有74.8％ (178/238)的患者使用吗啡止痛有良好的疗效,25.2％ (60/238)患者对吗啡不耐受.行阿片转换治疗的患者中,76.7％ (46/60)的患者成功控制了疼痛,但羟考酮组与芬太尼组在疗效方面比较无差异(70.0％ vs 83.3％,P=0.222).60例患者阿片转换前后发生便秘(63.3％ vs 18.3％,P=0.000)及恶心呕吐(55.0％ vs 21.7％,P=0.000)等不良反应的差异有统计学意义,但两组比较无差异.结论 对于吗啡不耐受的癌痛患者转换应用口服羟考酮或芬太尼贴剂能显著提高疼痛控制率,改善患者生活质量.

Clinical study of opioid switching from oral morphine to oral oxycodone versus oral morphine to transdermal fentanyl in patients who were non-responders with oral morphine

OBJECTIVE The aim of this study is to prospectively evaluate individual variation in sensitivity to morphine and the need,clinical benefits and side effects of switching from morphine to an alternative opioid in advanced cancer patients.METHODS 238 patients with moderate or severe cancer pain were prospectively recruited and given oral morphine as the treatment.The purpose was to evaluate the patients were responders or non-responders(switchers).The switchers were randomly divided into Oxycodone group(They were converted from oral morphine to oral oxycodone.)and Fentany1 group(They were converted from oral morphine to transdermal fentanyl).The clinical efficiency was recruited by numerial rating scale(NRS)on 10 days after opioid switching.We evaluated whether the two groups had differences.RESULTS In this study,74.8%(178/238)had a good response to morphine(responders).25.2%(60/238)who did not respond to morphine switched to an alternative opioid(switchers).Overall successful pain control with minimal side effects was achieved in 76.7%(46/60)of switchers,but there were no statistical differences between two groups in the analgesic of opioid switching(70.0% vs 83.3%,P = 0.222).Before and after switching,constipation(63.3% vs 18.3%,P = 0.000)and nausea/vomiting(55.0% vs 21.7%,P = 0.000)were significantly different.Furthermore,no statistical differences were found in the side effects between two groups.CONCLUSION Opioid switchings of oxycodone and fentanyl regimens significantly improve the balance between pain control and side effects for cancer patients who fail to control pain with oral morphine.