芬太尼透皮贴剂治疗1 664例老年癌痛的临床疗效分析

目的探讨老年癌症疼痛病人接受芬太尼透皮贴剂治疗的止痛疗效及安全性.方法全国23个省自治区、直辖市136家医院共1 664例,年龄≥65岁的老年癌痛病人接受了芬太尼透皮贴剂的止痛治疗,平均年龄72.6岁(65～90岁).芬太尼透皮贴剂的初始、15 d和30 d用药剂量均值分别为 31.34 μg/h,40.59 μg/h和47.50 μg/h (25～200 μg/h).结果治疗前疼痛程度评分为7.34.治疗1 d、3 d、6 d、9 d、15 d、30 d疼痛程度评分均值分别降低至3.82,2.80,2.43,2.11,1.83,1.79 (P<0.01),总有效率97.18%.治疗前25.4%的病人生活质量良好,治疗后15 d和30 d,71.15%和73.04%病人生活质量良好(P<0.01).不良反应便秘为10.70%,恶心为11.96%,头晕为6.85%,呕吐为3.85%,嗜睡为2.40%,呼吸抑制为0.12%.86.2%病人选择继续用芬太尼透皮贴剂.结论芬太尼透皮贴剂治疗老年癌痛病人安全有效,病人满意度高.推荐老年病人的初始剂量为25 μg/h.

Transdermal fentanyl for the management of cancer pain: a survey of 1,664 elderly patients

OBJECTIVE: To evaluate the effects and side effects of transdermal fentanyl for the elderly patients with cancer pain. METHODS: A multicenter clinical test was conducted among 1,664 patients with cancer pain, aged 65 - 90 with a median age of 71, 879 (52.8%) of which used opioid for the first time, from 136 hospitals in 23 provinces in China. All patients received transdermal fentanyl to treat cancer pain with the mean dose of fentanyl of 31.34 micro g/h (25 - 150 micro g/h) initially, and 40.59 micro g/h and 47.50 micro g/h (25 - 200 micro g/h) at day 15 and day 30. They were asked to record the attacks of pain, quality of life, and any side effects of the treatment. RESULTS: The baseline pain intensity score was 7.34. On days 1, 3, 6, 9, 15, and 30, the mean pain scores were decreased to 3.82, 2.80, 2.43, 2.11, 1.83, and 1.64 (all P < 0.01) respectively. The effective rate was 97.18%. The fine life quality rate was 25.4% before treatment, and was 71.15% and 73.04% at day 15 and day 30 (both P < 0.01). The commonest side effects included constipation (10.70%), nausea (11.96%), dizziness (6.85%), vomiting (3.85%), sleepiness (2.40%), and respiratory depression (0.12%). The incidence of constipation was related with age, the incidence of vomiting and difficulty of urination was related with gender. 86.2% patients preferred to receive transdermal fentanyl. CONCLUSION: Safe, convenient, and capable to improve the quality of life, transdermal fentanyl is effective and worth recommending as a first-line drug for the treatment of elderly patients with moderate to severe cancer pain. The initial dose is recommended as 25 micro g/h.