阿片类未耐受患者芬太尼静脉自控镇痛滴定芬太尼透皮贴剂的安全性与有效性

发布时间：2018-10-31 07:15

【摘要】：目的:评价阿片类药物未耐受患者应用芬太尼静脉自控镇痛(patient controlled intravenous analgesia,PCIA)滴定芬太尼透皮贴剂(多瑞吉)的安全性和有效性。方法:收集江苏省肿瘤医院镇痛科2012年1月至2015年7月住院中重度癌痛患者30例,采用开放非对照试验,使用芬太尼PCIA滴定多瑞吉治疗癌性疼痛,记录滴定情况、疼痛评分、疼痛对患者生活的影响评分和不良反应。结果:全组20例滴定成功,10例滴定失败(其中8例疼痛缓解不佳,2例不良反应无法耐受而中断滴定)。20例滴定成功患者的疼痛评分在芬太尼PCIA、PCIA+多瑞吉和多瑞吉治疗后较PCIA前的一般疼痛评分、最严重时评分、活动时评分和静息时评分均显著下降(P0.05),PCIA+多瑞吉较PCIA的所有疼痛评分均显著下降(P0.05),多瑞吉较PCIA的一般疼痛评分和静息时评分显著下降(P0.05),而活动时评分和最严重时评分比较无显著性差异(P0.05)。疼痛对于患者生活影响评分方面,20例滴定成功患者在PCIA、PCIA+多瑞吉和多瑞吉治疗后较PCIA治疗前均显著改善(P0.05),PCIA+多瑞吉治疗和多瑞吉时较PCIA患者除行走能力外均显著改善(P0.05),多瑞吉较PCIA+多瑞吉患者无显著性差异(P0.05)。所有的不良反应在滴定后较滴定前除恶心外均无显著性差异(P0.05),未观察到肌肉强直、意识丧失、呛咳、呼吸抑制和心动过缓等不良反应。结论:对于适合芬太尼透皮贴剂镇痛的阿片类药物未耐受患者,应用芬太尼PCIA滴定安全有效,简单易行。
[Abstract]:Aim: to evaluate the safety and efficacy of fentanyl (patient controlled intravenous analgesia,PCIA) titration of fentanyl transdermal patch in patients with opioid intolerance. Methods: from January 2012 to July 2015, 30 patients with moderate and severe cancer pain were collected from Analgesia Department of Jiangsu Cancer Hospital. The patients were treated with fentanyl PCIA titration for cancer pain, and the titration status and pain score were recorded. Scores and adverse effects of pain on patients' lives. Results: the titration was successful in 20 cases and failed in 10 cases (including 8 cases of pain relief, 2 cases of adverse reaction and interrupted titration). The pain score of 20 cases of successful titration was evaluated in fentanyl PCIA,. After treatment, the general pain scores of PCIA and doregis were significantly lower than those of PCIA, and the scores of most severe, active and resting were significantly lower than those of PCIA (P0.05). Compared with PCIA general pain score and resting score decreased significantly (P0.05), but there was no significant difference between activity score and worst score (P0.05). In terms of the impact of pain on patients' life scores, 20 successful titrated patients were significantly better than those before the treatment of PCIA after treatment with PCIA,PCIA doregis and doregis (P0.05). Compared with the patients with PCIA, the walking ability of the patients with PCIA was significantly improved (P0.05), while that of the patients with PCIA was not significantly higher than that of the patients with PCIA (P0.05). There was no significant difference in all adverse reactions after titration except nausea (P0.05). No adverse reactions such as muscle rigidity loss of consciousness choking cough respiratory depression and bradycardia were observed. Conclusion: fentanyl PCIA titration is safe, effective and simple for opioid patients who are suitable for fentanyl transdermal analgesia.
【作者单位】：江苏省肿瘤医院镇痛科南京医科大学附属肿瘤医院镇痛科;江苏省肿瘤医院肿瘤内科南京医科大学附属肿瘤医院肿瘤内科;
【基金】：江苏省肿瘤医院科研基金面上项目(编号:ZM201205)资助~~
【分类号】：R730.5;R614

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