静脉自控镇痛治疗顽固性癌痛的临床疗效分析*

目的：比较口服羟考酮控释片（oxycodone hydrochloride controlled-release tablets，OHCT）与静脉自控镇痛（patient-controlled intravenous analgesia ，PCIA）治疗顽固性癌痛的疗效、不良反应、治疗费用以及患者的满意率。方法：收集2012年9 月至2014年3 月福建医科大学附属第二医院及南京军区福州总医院肿瘤内科收治的顽固性癌痛患者89例，其中OHCT 组47例，治疗方案为口服羟考酮控释片60～400 mg/d ，每12h 给药1 次；PCIA组42例，给药方式为“背景量+ 患者自控给药量”模式，视患者镇痛效果调节药物浓度。比较两组镇痛效果、不良反应、治疗费用以及患者的满意率。结果：换算后两组镇痛模式吗啡日均剂量比较无显著性差异（P > 0.05），PCIA组镇痛后24hVAS评分及日均VAS 评分低于OHCT 组（P < 0.05），PCIA组出现恶心、呕吐的频率低于OHCT 组（P < 0.05），PCIA组的治疗费用、满意率与OHCT 组比较无显著性差异（P > 0.05）。 结论：PCIA组镇痛效果优于OHCT组，不良反应更小，而其治疗费用、满意率与OHCT 组相仿，值得临床进一步推广。

Clinical efficacy of patient-controlled intravenous analgesia for intractable cancer pain

Objective: To compare the clinical efficacy of oxycodone hydrochloride controlled- release tablets (OHCT) and pa -tient-controlled intravenous analgesia (PCIA) in the treatment of intractable cancer pain. Methods:Retrospective analysis was conduct-ed to evaluate the intractable cancer pain of 89elderly patients who were admitted to the medical oncology departments of The Second Affiliated Hospital of Fujian Medical University and the Fuzhou General Hospital of Nanjing Military Command between September 2012and March 2014. Among the 89patients, 47were treated with OHCT, and 42received PCIA. The total dosage ranged from 60mg/ d to 400 mg/d PO q12h for patients in the OHCT group, whereas a "background dose + patient-controlled dose" mode was adopted for patients in the PCIA group. The therapeutic efficacy, presence of adverse reactions, cost of treatment, and degree of patient satisfaction were compared between the two groups. Results:The average dosages of analgesics in the two groups were almost the same ( P>0.05). Visual analogue scale (VAS) values and daily average VAS values were both lower in the PCIA group than in the OHCT group at 24h after analgesia (P<0.05). The incidence of adverse reactions, such as nausea and vomiting, was also lower in the PCIA group than in the OHCT group ( P<0.05). The cost of treatment and degree of patient satisfaction were the same in both groups ( P>0.05). Conclusion:Pa-tients who received PCIA attained better analgesia and exhibited less adverse reactions than those who received OHCT whereas the treatment cost and patient satisfaction did not differ in both groups.