吗啡控释片治疗癌性疼痛的疗效和安全性评价

目的：通过Meta分析,评估吗啡控释片直肠给药在癌性疼痛治疗中的临床应用价值。方法：检索中国生物医学文献库（CBMdisc）、中国期刊全文数据库、维普数据库（VIP）等国内数据库已发表的相关文献,收集国内有关吗啡控释片直肠给药治疗癌性疼痛的临床随机、对照试验（randomized controlled trials,RCT）,由2位评价者分别按检索策略收集并纳入标准入选资料,分析指标为疼痛缓解率和不良反应发生率。结果：8个研究共598例患者纳入分析,吗啡控释片直肠给药和口服给药的疼痛缓解率分别是83.69%和87.97%（P=0.09）;在不良反应方面,吗啡控释片直肠给药导致便秘的发生率降低了15%（P〈0.000 1）,消化道反应的发生率降低了21%（P〈0.000 1）,嗜睡头晕的发生率降低了9%（P=0.001）。结论：吗啡控释片直肠给药和口服给药治疗中重度癌性疼痛的效果相近,但直肠给药不良反应的发生率可能较低,临床医生应根据患者个体情况合理选用。

Efficacy and Safety of Morphine Controlled Release Tablet for Cancer Pain

OBJECTIVE: To evaluate the clinical application value of morphine controlled release tablet for cancer pain through meta-analysis.METHODS: The randomized controlled trials(RCTs) on morphine controlled release tablet per rectum for treatment of cancer pain published in pertinent literature were retrieved from domestic electronic databases including CBMdisc,CNKI and VIP.The data collection and inclusion were performed by two assessors in accordance with retrieval strategy and inclusion criteria.The pain remission rate and incidence of adverse drug reaction were used as indexes for analysis.RESULTS: The meta-analysis included 8 trials including 598 cases.The pain remission rate in patients receiving morphine controlled release tablet per rectum vs.per ors stood at 83.69% vs.87.97%(P=0.09).With regard to adverse drug reactions,the per rectum group decreased by 15% in the incidence of constipation(P<0.000 1),by 21% in adverse drug reaction of digestive system(P<0.000 1) and by 9% in incidence of drowsiness and dizziness(P=0.001).CONCLUSION: Morphine controlled release tablet per rectum is as effective as Morphine controlled release tablet per os yet the former is less toxic than the latter.Clinicians should make a reasonable choice based on patients’ individual condition.