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1、臨床腫瘤學(xué)雜志2009年3月第14卷第3期ChineseClinicalOncology,Mar.2009,Vol.14,No.3·221·大劑量阿片類藥物治療癌性疼痛回顧性分析210002南京解放軍八一醫(yī)院全軍腫瘤中心內(nèi)科陳映霞,秦叔逵,方蓉,張玨,唐慶慶,劉靜冰,成遠(yuǎn),王琳【摘要】目的:觀察大劑量阿片類止痛藥物控制國(guó)人癌性疼痛的療效及安全性。方法:八一醫(yī)院腫瘤內(nèi)科2005年1月~2009年2月住院治療晚期惡性腫瘤患者中,有21例因重度疼痛而需要大劑量阿片類(口服嗎啡等效劑量為≥300mg/d
2、)治療,回顧性分析其臨床診斷,阿片類滴定時(shí)間、劑量、使用持續(xù)時(shí)間以及毒副反應(yīng)。結(jié)果:21例中,16例為胃腸道腫瘤;14例存在骨骼轉(zhuǎn)移,8例有腹膜后淋巴結(jié)轉(zhuǎn)移;軀體痛14例,神經(jīng)性疼痛和內(nèi)臟痛各9例。治療過(guò)程中17例患者經(jīng)歷阿片類轉(zhuǎn)換。滴定至最大劑量的時(shí)間為4~378d(中位時(shí)間92d)。最大劑量范圍為330d~1200mg/d(中位數(shù)450mg/d)。大劑量阿片類持續(xù)時(shí)間為12~255d(中位時(shí)間61d)。出現(xiàn)疼痛后生存期為2~45個(gè)月(中位數(shù)11個(gè)月)。未出現(xiàn)威脅生命的毒副反應(yīng)。結(jié)論:大劑量阿
3、片類止痛藥對(duì)具有重度疼痛的國(guó)人晚期腫瘤患者是安全有效的?!娟P(guān)鍵詞】癌性疼痛;處理;阿片類;大劑量中圖分類號(hào):R7305;R7306文獻(xiàn)標(biāo)識(shí)碼:A文章編號(hào):1009-0460(2009)03-0221-04AretrospectiveanalysisofhighdoseopioidsanalgesicsmanagementforcancerpainCHENYingxia,QINShukui,FANFRong,ZHANGJue,TANGQingqing,LIUJingbin,CHENG
4、Yuan,WANGLin.DepartmentofOncology,PLACancerCenter,81HospitalofPLA,Nanjing210002,China【Abstract】Objective:ToobservetheeffectiveandsafeofhighdoseopioidanalgesicsinChinesepatientswithcancerpain.Methods:Toretrospectivelyanalyzetheclinicaldataof21patient
5、swhoreceivedhighdoseopioidsanalgesics(oralmorphineequivalentdose≥300mg/d)forseverecancerpainrelieffromJanuary2005toFebruary2009.Tocollecteddataregardingmedicaldiagnosis,opioidanalgesicstitration,opioidanalgesicsdosage,andsurvivaltimeasassociatedwit
6、hopioidanalgesics,andthesideeffectofopioidanalgesics.Results:Of21patients,therewere16withgastroenterictumor,14withbonemetastasis,8withretroperitoneallymphnodemetastasis,14withsomaticpain,9withneuropathicpain,and9withvisceralgia.Seventeenpatientsnee
7、dedopioidrotationforpainrelieforadverseeffectsdecrease.Thetimetomaximumdoseofopioidsanalgesicswere4daysto378days(Median92days).Thedurationofhighdoseopioidsanalgesicswereinrangeof12daysto255days(median,61days).Themaximumdoseofopioidsanalgesicswere33
8、01200mg/day(median,450mg/day).Thesurvivaltimeaftercancerpainwere145months(median,11months).Therewerentlifethreateningsideeffects.Conclusion:TheuseofhighdoseopioidsanalgesicsprovedsafeandeffectivenessforChinesepatientswithseverecancerpain.【KeyW