强阿片类药物在不同消化系统状况下晚期中重度癌痛患者中的镇痛价值研究

目的探讨强阿片类药物在不同消化系统状况下晚期中重度癌痛患者中的镇痛价值。方法选取我院收治的102例晚期中、重度癌痛患者,根据原发肿瘤发病部位,分为消化系统源性组(46例)和非消化系统源性组(56例)。记录各组重度癌痛情况、癌痛控制状况、癌痛类型和日均消耗吗啡当量,2周后进行疼痛缓解度评价。结果消化系统源性组和非消化系统源性组止痛治疗的总有效率分别为93.48%、91.07%,两组比较差异无统计学意义(P>0.05)。两组患者的躯体痛、大便超过3 d未排、芬太尼贴剂为主的例数比较差异有统计学意义(P<0.01)。两组患者排便间隔≤3 d、排便间隔>3 d患者重度疼痛比例比较差异无统计学意义(P>0.05),两组排便间隔≤3 d患者的疼痛控制总有效率高于排便间隔>3 d的患者(P<0.01),日均吗啡当量低于排便间隔>3 d的患者(P<0.01);两组排便间隔>3 d患者的重度疼痛比例、疼痛控制总有效率和日均吗啡当量比较差异无统计学意义(P>0.05)。结论消化系统源性、非消化系统源性的晚期癌症患者,采用阿片类药物或芬太尼透皮贴剂均可达到较好的癌痛控制效果,而消化系统源性患者更倾向于接受芬太尼贴剂作为主要维持用药,但对于排便间隔>3 d的患者镇痛效果不佳。

Application value of strong opioids in moderate to severe cancer pain of advanced cancer patients under different digestive conditions

Objective To explore the analgesic value of strong opioids in moderate to severe cancer pain of advanced cancer patients under different digestive conditions. Methods A total of 102 advanced cancer patients in our hospital with moderate to severe cancer pain were selected. Patients were divided into digestive-derived group (n=46) and non-digestive-derived group( n=56 )according to the primary tumor site. The severe cancer pain,pain control, type of pain and the morphine equivalent daily dose in each group were recorded,and the pain remission was evaluated after 2 weeks. Results The total analgesic efficiency in digestive-derived group and non-digestive-derived group was 93. 48% and 91. 07% respectively,no significant difference was found between the two groups( P﹥0. 05). There were significant differences in the somatic pain,no stool row for more than 3 d and fentanyl patch based ratio between the two group(P﹤0. 01). There was no significant difference in the proportion of severe pain in patients with defecation interval ≤3 d and ﹥3 d between the two groups(P﹥0. 05),and the total pain control rate of patients with defecation interval ≤3 d was higher than patients with defecation interval ﹥3 d(P﹤0. 01)with less average daily volume(P﹤0. 01). There was no significant difference in proportion of severe pain,total pain control rate and morphine equivalent daily dose of patients with defecation interval﹥3 d between the two groups( P﹥0. 05). Conclusion Opioids or trans-dermal fentanyl patch is effective in controlling the cancer pain of patients with both digestive-derived and non-digestive derived advanced cancer. Patients with digestive-derived cancer tend to accept fentanyl patch as the main maintenance drug,which has poor effect on patients with defecation interval﹥ 3 d.