晚期肺癌癌痛患者口服吗啡转换为芬太尼贴剂的临床疗效

目的探讨晚期肺癌癌痛患者由口服吗啡转换应用芬太尼透皮贴剂的临床疗效。方法59例口服吗啡镇痛不满意的晚期肺癌伴重度癌痛患者，换用芬太尼透皮贴剂止痛，剂量换算公式为：芬太尼透皮贴剂72h剂量（μg/h）=口服吗啡（mg/d）×0．5，根据疼痛评分调整剂量，将疼痛控制在3分以下。数字评分法记录疼痛强度、生活质量和不良反应评分。结果59例晚期肺癌癌痛患者药物转换后疼痛强度明显降低，转换前疼痛评分均值为（6．27±1．15）分，转换后6d为（2．15±0．87）分，15d为（2．03±0．68）分，30d为（1．95±0．73）分（P〈0．01）。总的疼痛缓解率81．35％。转换后生活质量评分明显提高（P〈0．05），不良反应如恶心／呕吐和便秘发生率降低，但皮肤瘙痒的发生率提高（P〈0．05）。结论无法应用口服吗啡镇痛的晚期肺癌癌痛患者，转换应用芬太尼贴剂后，镇痛效果提高，生活质量得到明显改善。

A algesic effects of transdermal fentanyl switching from oral morphine on advanced lung cancer patiants with severe pain

Objective To evaluate the analgesic effects of transdermal fentanyl switching from oral morphine on advanced lung cancer patients with severe pain. Methods 59 advanced lung cancer patients with severe pain who could not take orally and bare the side effect converted from oral morphine to transdermal fentanyl. A dose ratio with transdermal fentanyl（ug/h） per72h=oral morphine（mg/d）＊0.5 was calculated. The intensity of pain was recorded with numeric rating scale （NRS）. The quality of life and any side effects were recorded. Results Pain intensity decreased significantly after switching. The mean pain score decreased from （6.27±1.15）to（2.15 ±0.87）on 6 day, （2.03 ±0.68 ）on 15day, （1.95±0.73） on 30 day after switching respectively （P〈0.01）. The total remission rate was 81.35% after switching. The quality of life after switching was improved obviously. Some side effects such as the nausea,vomiting and constipation were relieved. But the rate of Skin itch was increased （P〈0.05）. Conclusions Transdermal fentanyl may be effective on the treatment of advanced lung cancer patients with severe pain who failed to control pain with oral morphine. The quality of life after switching was improved obviously.