芬太尼透皮贴剂或静脉吗啡泵维持治疗中重度癌痛疗效的临床观察

目的:观察和比较持续静脉泵入吗啡与芬太尼透皮贴治疗中重度癌痛的临床疗效和安全性。方法:选择40例疼痛评分＞4的中重度癌痛患者，进行疼痛滴定后随机分为吗啡组(持续静脉泵入吗啡)与芬太尼组(芬太尼透皮贴)。观察和比较两组患者的镇痛疗效、镇痛维持时间、爆发痛发作次数及不良反应发生情况。结果:治疗后，吗啡组和芬太尼组的NRS评分分别为(1.9±0.8)分和(2.2±1.0)分，均较治疗前明显降低(P＜0.05)，但两组间的差异无统计学意义(P＞0.05)；吗啡组患者每天平均镇痛维持时间为(22.7±0.4)小时，爆发痛每天发作(1.0±0.3)次；芬太尼组每天平均镇痛维持时间为(20.14±1.2)小时，爆发痛每天发作(1.5±0.6)次，两组间的差异均无统计学意义(P＞0.05)。两组患者的不良反应以便秘多见，经对症处理后均可耐受。两组生活质量均得到明显提高。结论:持续静脉泵入吗啡及芬太尼透皮贴治疗中重度癌痛均可明显缓解患者的疼痛症状，镇痛效果及安全性相当。

Clinical observation of fentany transdermal system and intravenous morphine pump in the maintenance of moderate or severe cancer pain

Objective:To observe the clinical efficacy and safety of continuous intravenous infusion of morphine and fentanyl transdermal patches in the treatment of moderate and severe cancer pain.Methods:A total of 40 patients with moderate or severe cancer pain with pain score>4 were randomly divided into morphine group (continuous intravenous infusion of morphine) and fentanyl group (fentanyl transdermal patch).The analgesic efficacy,the duration of analgesia,the number of episodes of explosive pain and the incidence of adverse reactions were observed.Results:After treatment,the NRS scores of the morphine group and the fentanyl group were (1.9±0.8) and (2.2±1.0) respectively (P＞0.05),but all decreased significantly when compared with the scores before treatment(P＜0.05).The average duration of pain relief in the morphine group was (22.7±0.4) hours,and the onset of explosive pain was(1.0±0.3) times per day.The average pain relief time of fentanyl group was (20.14±1.2) hours,and the outbreak of explosive pain was two (1.5±0.6) times per day,the difference between the two groups was not statistically significant (P＞0.05).The side effects of the two groups were constipation,which could be tolerated by symptomatic treatment.The quality of life of the two groups was obviously improved.Conclusion:Continuous intravenous infusion of morphine and fentanyl transdermal in the treatment of severe cancer pain can alleviate the symptoms of pain,recommending the use of long-term hospitalized patients with continuous intravenous infusion of morphine,and Outpatients with fentanyl transdermal therapy.