阿片类药物在癌痛治疗中的应用
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摘要
癌痛是肿瘤患者最常见的症状。癌痛管理是肿瘤综合治疗的重要组成部分,良好的疼痛控制可以增加患者对抗肿瘤治疗的依从性,提高患者及家属的生活质量。合理使用阿片类药物,选择正确的阿片类药物,正确的给药途径和给药间隔是癌痛治疗成功的关键。本文介绍了阿片类药物的分类和作用机制,详细分析了口服给药途径、经黏膜/皮肤给药途径、静脉/皮下给药途径、轴索镇痛等4类给药途径的优缺点及临床应用,为临床医护人员合理使用阿片类药物提供指导。
Cancer pain is the most common symptomin cancer patients. Cancer pain management is an important part of comprehensive treatment for tumors. Good pain control can increase the compliance of patients with cancer treatment and improve the quality of life of patients and their families. Rational use of opioid drugs,including the correct choice of opioid drugs,the correct way of drug delivery and drug delivery interval,are the keys to successful cancer pain treatment. The main purpose of this reviewis to introduce the classification of opioids and mechanismof action,make a detailed analysis of oral drug delivery way,delivery way through the skin mucous/membrane,intravenous/subcutaneous delivery way,and neuraxial analgesia,and the advantages and disadvantages of the four types of method,and their clinical application will be discussed to provide guidance for clinical medical staff to use opioid drugs properly.
Cancer pain is the most common symptomin cancer patients. Cancer pain management is an important part of comprehensive treatment for tumors. Good pain control can increase the compliance of patients with cancer treatment and improve the quality of life of patients and their families. Rational use of opioid drugs,including the correct choice of opioid drugs,the correct way of drug delivery and drug delivery interval,are the keys to successful cancer pain treatment. The main purpose of this reviewis to introduce the classification of opioids and mechanismof action,make a detailed analysis of oral drug delivery way,delivery way through the skin mucous/membrane,intravenous/subcutaneous delivery way,and neuraxial analgesia,and the advantages and disadvantages of the four types of method,and their clinical application will be discussed to provide guidance for clinical medical staff to use opioid drugs properly.
引文
[1] Deandrea S,Montanari M,Moja L. Prevalence of undertreatment in cancer pain:a review of published literature[J]. Ann Oncol,2008,19(12):1885-1891.
[2] Scarborough BM,Smith CB. Optimal pain management for patients w ith cancer in the modern era[J]. CA Cancer J Clin,2018,68(3):182-196.
[3] Levy MH. Pharmacologic treatment of cancer pain[J]. N Engl J M ed,1996,335(15):1124-1132.
[4] Ventafridda V,Tamburini M,Caraceni A,et al. A validation study of the WHO method for cancer pain relief[J]. Cancer,1987,59(4):850-856.
[5] Mercadante S. The use of opioids for treatment of cancer pain[J]. Expert Opin Pharmacother,2015,16(3):389-394.
[6] Pergolizzi J,Aloisi AM,Dahan A. Current knowledge of buprenorphine and its unique pharmacological profile[J]. Pain Pract,2010,10(5):428-450.
[7] Trescot AM. Review of the role of opioids in cancer pain[J]. J Natl Compr Canc Netw,2010,8(9):1087-1094.
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[10] Riley J,Branford R,Droney J. Morphine or oxycodone for cancer-related pain? A randomized,open-label,controlled trial[J]. J Pain Symptom Manage,2015,49(2):161-172.
[11]芬太尼透皮贴剂临床试验协作组.芬太尼透皮贴剂治疗癌痛临床研究[J].中华麻醉学杂志,2003,23(6):469-470.
[12] Clemens KE,Klaschik E. Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study[J]. Jpn J Clin Oncol,2007,37(4):302-309.
[13] Mercadante S. Parenteral routes for opioid administration in cancer pain management[J]. Eur J Intern Med,2016,34:e39-e40.
[14] Glare P,Walsh D,Groh E,et al. The efficacy and side effects of continuous infusion intravenous morphine(CIVM)for pain and symptoms due to advanced cancer[J]. Am J Hosp Palliat Care,2002,19(5):343-350.
[15]覃韬,但嵩山,黎阳,等.开胸恶性肿瘤切除术后多模式镇痛[J].实用医学杂志,2017,33(8):1266-1269.
[16]刘宏宇,孟馥芬,刘亚华.不同镇痛方法在开胸术后疼痛管理中的应用效果比较[J].中国医药,2016,11(3):399-403.
[17]杨晓英,沈韩雄,马思杰,等.针刺复合静脉麻醉用于甲状腺良性结节消融术的临床观察[J].世界中医药,2018,13(6):1537-1540.
[18]王玉嘉,葛春林.右美托咪定联合舒芬太尼对产妇剖宫产术后的镇痛效果[J].中国医药,2018,13(7):1087-1090.
[19]毕小宝,王琼,张高龙,等.纳布啡与舒芬太尼用于宫腔镜手术的麻醉效果比较[J].实用医学杂志,2018,34(18):3085-3088.
[20] Myers J,Chan V,Jarvis V. Intraspinal techniques for pain management in cancer patients:a systematic review[J]. Support Care Cancer,2010,18(2):137-149.
[21] Smyth CE,Jarvis V,Poulin P. Brief review:neuraxial analgesia in refractory malignant pain[J]. Can J Anaesth,2014,61(2):141-153.
[22] Textor LHCE. Intrathecal pumps for managing cancer pain[J]. Am J Nurs,2016,116(5):36-44.
[23]罗超,杨蓓,权哲峰,等.鞘内注射芬太尼对蛛网膜下腔麻醉行剖宫产术产妇寒战的影响[J].中国医药,2016,11(4):577-580.
[24]中国抗癌协会癌症康复与姑息治疗专业委员会(CRPC)难治性癌痛学组.难治性癌痛专家共识(2017年版)[J].中国肿瘤临床,2017,44(16):787-793.
[2] Scarborough BM,Smith CB. Optimal pain management for patients w ith cancer in the modern era[J]. CA Cancer J Clin,2018,68(3):182-196.
[3] Levy MH. Pharmacologic treatment of cancer pain[J]. N Engl J M ed,1996,335(15):1124-1132.
[4] Ventafridda V,Tamburini M,Caraceni A,et al. A validation study of the WHO method for cancer pain relief[J]. Cancer,1987,59(4):850-856.
[5] Mercadante S. The use of opioids for treatment of cancer pain[J]. Expert Opin Pharmacother,2015,16(3):389-394.
[6] Pergolizzi J,Aloisi AM,Dahan A. Current knowledge of buprenorphine and its unique pharmacological profile[J]. Pain Pract,2010,10(5):428-450.
[7] Trescot AM. Review of the role of opioids in cancer pain[J]. J Natl Compr Canc Netw,2010,8(9):1087-1094.
[8] Boland JW,Ziegler L. Boland EGIs regular systemic opioid analgesia associated w ith shorter survival in adult patients w ith cancer? A systematic literature review[J]. Pain,2015,156(11):2152-2163.
[9] Biancofiore G. Oxycodone controlled release in cancer pain management[J]. Ther Clin Risk M anag,2006,2(3):229-234.
[10] Riley J,Branford R,Droney J. Morphine or oxycodone for cancer-related pain? A randomized,open-label,controlled trial[J]. J Pain Symptom Manage,2015,49(2):161-172.
[11]芬太尼透皮贴剂临床试验协作组.芬太尼透皮贴剂治疗癌痛临床研究[J].中华麻醉学杂志,2003,23(6):469-470.
[12] Clemens KE,Klaschik E. Clinical experience with transdermal and orally administered opioids in palliative care patients--a retrospective study[J]. Jpn J Clin Oncol,2007,37(4):302-309.
[13] Mercadante S. Parenteral routes for opioid administration in cancer pain management[J]. Eur J Intern Med,2016,34:e39-e40.
[14] Glare P,Walsh D,Groh E,et al. The efficacy and side effects of continuous infusion intravenous morphine(CIVM)for pain and symptoms due to advanced cancer[J]. Am J Hosp Palliat Care,2002,19(5):343-350.
[15]覃韬,但嵩山,黎阳,等.开胸恶性肿瘤切除术后多模式镇痛[J].实用医学杂志,2017,33(8):1266-1269.
[16]刘宏宇,孟馥芬,刘亚华.不同镇痛方法在开胸术后疼痛管理中的应用效果比较[J].中国医药,2016,11(3):399-403.
[17]杨晓英,沈韩雄,马思杰,等.针刺复合静脉麻醉用于甲状腺良性结节消融术的临床观察[J].世界中医药,2018,13(6):1537-1540.
[18]王玉嘉,葛春林.右美托咪定联合舒芬太尼对产妇剖宫产术后的镇痛效果[J].中国医药,2018,13(7):1087-1090.
[19]毕小宝,王琼,张高龙,等.纳布啡与舒芬太尼用于宫腔镜手术的麻醉效果比较[J].实用医学杂志,2018,34(18):3085-3088.
[20] Myers J,Chan V,Jarvis V. Intraspinal techniques for pain management in cancer patients:a systematic review[J]. Support Care Cancer,2010,18(2):137-149.
[21] Smyth CE,Jarvis V,Poulin P. Brief review:neuraxial analgesia in refractory malignant pain[J]. Can J Anaesth,2014,61(2):141-153.
[22] Textor LHCE. Intrathecal pumps for managing cancer pain[J]. Am J Nurs,2016,116(5):36-44.
[23]罗超,杨蓓,权哲峰,等.鞘内注射芬太尼对蛛网膜下腔麻醉行剖宫产术产妇寒战的影响[J].中国医药,2016,11(4):577-580.
[24]中国抗癌协会癌症康复与姑息治疗专业委员会(CRPC)难治性癌痛学组.难治性癌痛专家共识(2017年版)[J].中国肿瘤临床,2017,44(16):787-793.