羟考酮与曲马多对老年中度癌痛患者初始治疗效果的比较
|
摘要
目的探讨在老年中度癌痛患者中,羟考酮与曲马多作为初始止痛治疗方案的疗效。方法 96例老年中度癌痛患者,按治疗方式不同分为观察组(n=49)和对照组(n=47)。观察组患者初始治疗直接采用盐酸羟考酮缓释片10 mg q12 h口服;对照组先采用盐酸曲马多缓释片100 mg q12 h口服,根据疼痛控制情况逐渐加量改用盐酸羟考酮缓释片20 mg q12 h继续止痛治疗,两组患者观察时间为14天。分别采用数字评分法(NRS)、卡氏功能状态(KPS)评分、汉密尔顿抑郁量表(HAMD)、生活质量评分量表对患者的疼痛情况、功能状态、抑郁情况、生活质量进行评估。结果治疗前两组患者NRS、HAMD及KPS评分比较,差异均无统计学意义(P﹥0.05);治疗后两组患者NRS、HAMD评分均下降,与治疗前比较,差异均有统计学意义(P﹤0.05),且观察组患者NRS、HAMD评分均明显低于对照组,差异均有统计学意义(P﹤0.01);治疗后两组患者KPS评分均提高,与治疗前比较,差异均有统计学意义(P﹤0.05),且观察组患者KPS评分明显高于对照组,差异有统计学意义(P﹤0.01)。观察组患者疼痛缓解总有效率为95.9%(47/49),明显高于对照组患者的72.3%(34/47),差异有统计学意义(P﹤0.01)。治疗后观察组患者生活质量优于对照组,差异有统计学意义(P﹤0.05)。治疗过程中,观察组患者便秘发生率明显高于对照组,差异有统计学意义(P﹤0.01);而两组患者其他不良反应发生率比较,差异均无统计学意义(P﹥0.05)。结论以羟考酮作为老年中度癌痛患者的初治用药,与曲马多比较,能明显减轻患者的痛苦,改善患者体力,有效消除患者负面情绪,降低患者的心理困扰程度,改善患者的生活质量,提高癌痛治疗效果,对老年肿瘤患者的中度癌痛初始治疗选择策略具有重要意义。
Objective To investigate the efficacy of oxycodone and tramadol as initial therapy for elderly patients with moderate cancer pain. Method The clinical profiles of 96 elderly patients with moderate cancer pain were divided into observation group(n=49) and control group(n=47) by respective therapy. The observation group was treated initially with oral oxycodone hydrochloride sustained release tablets 10 mg q12 h. The control group was first treated with tramadol hydrochloride sustained release tablets 100 mg q12 h, according to the situation of pain control, higer dose or switched to oxycodone hydrochloride sustained release tablets 20 mg q12 h, and patients were observed for 14 days. Numeric rating scale(NRS), Karnofsky performance status(KPS) scale, Hamilton depression scale(HAMD), and quality of life scale(QOLS) were used to evaluate the pain severity, functional status, depression status, and quality of life of cancer patients,respectively. Result The NRS, HAMD and KPS scores were similar between the two groups before treatment(P>0.05);after treatment, the scores of NRS and HAMD in both groups were decreased, and there were significant differences compared with those before treatment(P<0.05), besides, the NRS and HAMD scores in observation group were significantly lower than those in control group(P<0.01). After treatment, the KPS scores in both groups were improved, and there were significant differences compared with those before treatment(P<0.05), additionally, the observation group had significantly higher KPS score compared with control group(P<0.01). The overall pain response rate was 95.9%(47/49) in observation group, which was significantly higher than the 72.3%(34/47) in control group(P<0.01). Better QOLS score was noted in observation group compared with control group after treatment, with statistically significant difference noted(P<0.05). In the course of treatment, the incidence of constipation in observation group was significantly higher than that in control group(P<0.01), while there was no significant difference regarding the incidence of other complications(P>0.05). Conclusion Oxycodone as the initial therapy for elderly patients with moderate cancer pain, compared with tramadol, can obviously relieve the pain of the patients, improve the physical ability, besides, it can effectively eliminate the negative emotions, reduce the degree of psychological distress of patients, improving patients' quality of life, ameliorating the effect of cancer pain treatment, and it is of pivotal strategic significance in the choice of initial therapy for moderate cancer pain.
Objective To investigate the efficacy of oxycodone and tramadol as initial therapy for elderly patients with moderate cancer pain. Method The clinical profiles of 96 elderly patients with moderate cancer pain were divided into observation group(n=49) and control group(n=47) by respective therapy. The observation group was treated initially with oral oxycodone hydrochloride sustained release tablets 10 mg q12 h. The control group was first treated with tramadol hydrochloride sustained release tablets 100 mg q12 h, according to the situation of pain control, higer dose or switched to oxycodone hydrochloride sustained release tablets 20 mg q12 h, and patients were observed for 14 days. Numeric rating scale(NRS), Karnofsky performance status(KPS) scale, Hamilton depression scale(HAMD), and quality of life scale(QOLS) were used to evaluate the pain severity, functional status, depression status, and quality of life of cancer patients,respectively. Result The NRS, HAMD and KPS scores were similar between the two groups before treatment(P>0.05);after treatment, the scores of NRS and HAMD in both groups were decreased, and there were significant differences compared with those before treatment(P<0.05), besides, the NRS and HAMD scores in observation group were significantly lower than those in control group(P<0.01). After treatment, the KPS scores in both groups were improved, and there were significant differences compared with those before treatment(P<0.05), additionally, the observation group had significantly higher KPS score compared with control group(P<0.01). The overall pain response rate was 95.9%(47/49) in observation group, which was significantly higher than the 72.3%(34/47) in control group(P<0.01). Better QOLS score was noted in observation group compared with control group after treatment, with statistically significant difference noted(P<0.05). In the course of treatment, the incidence of constipation in observation group was significantly higher than that in control group(P<0.01), while there was no significant difference regarding the incidence of other complications(P>0.05). Conclusion Oxycodone as the initial therapy for elderly patients with moderate cancer pain, compared with tramadol, can obviously relieve the pain of the patients, improve the physical ability, besides, it can effectively eliminate the negative emotions, reduce the degree of psychological distress of patients, improving patients' quality of life, ameliorating the effect of cancer pain treatment, and it is of pivotal strategic significance in the choice of initial therapy for moderate cancer pain.
引文
[1] Davis MP, Walsh D. Epidemiology of cancer pain and factors influencing poor pain control[J]. Am J Hosp Palliat Care, 2004, 21(2):137-142.
[2] Li D, Li D, Song G, et al. Cancer survival in Cixian of China, 2003-2013:a population-based study[J]. Cancer Med,2018, 7(4):1537-1545.
[3] Yennurajalingam S, Tayjasanant S, Balachandran D, et al.Association between daytime activity, fatigue, sleep, anxiety, depression, and symptom burden in advanced cancer patients:a preliminary report[J]. J Palliat Med, 2016, 19(8):849-856.
[4] Goo AJ, Song YM, Shin J, et al. Factors associated with depression assessed by the patient health questionnaire-2 in long-term cancer survivors[J]. Korean J Fam Med, 2016, 37(4):228-234.
[5] Yi JC, Syrjala KL. Anxiety and depression in cancer survivors[J]. Med Clin North Am, 2017, 101(6):1099-1113.
[6] World HeaIth Organization(WHO). Cancer pain reIief and paIIiative care:report of a WHO Expert Committee[M]. Geneva:World HeaIth Organization, l990:l-75.
[7] Martin RC, Gerstenecker A, Nabors LB, et al. Impairment of medical decisional capacity in relation to Karnofsky Performance Status in adults with malignant brain tumor[J].Neurooncol Pract, 2015, 2(1):13-19.
[8] Odetunde MO, Akinpelu AO, Odole AC. Validity and reliability of a Nigerian-Yoruba version of the stroke-specific quality of life scale 2.0[J]. Health Qual Life Outcomes,2017, 15(1):205.
[9] Liu S, Yang L, Yuan Y, et al. Cancer incidence in Beijing,2014[J]. Chin J Cancer Res, 2018, 30(1):13-20.
[10] Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps[J]. Br J Anaesth, 2017, 119(4):723-736.
[11] Jara C, Del BS, Grávalos C, et al. SEOM clinical guideline for treatment of cancer pain(2017)[J]. Clin Transl Oncol,2018, 20(1):97-107.
[12] Bandieri E, Romero M, Ripamonti CI, et al. Randomized trial of low-dose morphine versus weak opioids in moderate cancer pain[J]. J Clin Oncol, 2016, 34(5):436-442.
[13] Tessaro L, Bandieri E, Costa G, et al. Use of oxycodone controlled-release immediately after NSAIDs:a new approach to obtain good pain control[J]. Eur Rev Med Pharmacol Sci, 2010, 14(2):113-121.
[14] Pan H, Zhang Z, Zhang Y, et al. Efficacy and tolerability of oxycodone hydrochloride controlled-release tablets in moderate to severe cancer pain[J]. Clin Drug Investig,2007, 27(4):259-267.
[15] Tassinari D, Drudi F, Rosati M, et al. The second step of the analgesic ladder and oral tramadol in the treatment of mild to moderate cancer pain:a systematic review[J]. Palliat Med, 2011, 25(5):410-423.
[16] Leppert W. Tramadol as an analgesic for mild to moderate cancer pain[J]. Pharmacol Rep, 2009, 61(6):978-992.
[2] Li D, Li D, Song G, et al. Cancer survival in Cixian of China, 2003-2013:a population-based study[J]. Cancer Med,2018, 7(4):1537-1545.
[3] Yennurajalingam S, Tayjasanant S, Balachandran D, et al.Association between daytime activity, fatigue, sleep, anxiety, depression, and symptom burden in advanced cancer patients:a preliminary report[J]. J Palliat Med, 2016, 19(8):849-856.
[4] Goo AJ, Song YM, Shin J, et al. Factors associated with depression assessed by the patient health questionnaire-2 in long-term cancer survivors[J]. Korean J Fam Med, 2016, 37(4):228-234.
[5] Yi JC, Syrjala KL. Anxiety and depression in cancer survivors[J]. Med Clin North Am, 2017, 101(6):1099-1113.
[6] World HeaIth Organization(WHO). Cancer pain reIief and paIIiative care:report of a WHO Expert Committee[M]. Geneva:World HeaIth Organization, l990:l-75.
[7] Martin RC, Gerstenecker A, Nabors LB, et al. Impairment of medical decisional capacity in relation to Karnofsky Performance Status in adults with malignant brain tumor[J].Neurooncol Pract, 2015, 2(1):13-19.
[8] Odetunde MO, Akinpelu AO, Odole AC. Validity and reliability of a Nigerian-Yoruba version of the stroke-specific quality of life scale 2.0[J]. Health Qual Life Outcomes,2017, 15(1):205.
[9] Liu S, Yang L, Yuan Y, et al. Cancer incidence in Beijing,2014[J]. Chin J Cancer Res, 2018, 30(1):13-20.
[10] Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps[J]. Br J Anaesth, 2017, 119(4):723-736.
[11] Jara C, Del BS, Grávalos C, et al. SEOM clinical guideline for treatment of cancer pain(2017)[J]. Clin Transl Oncol,2018, 20(1):97-107.
[12] Bandieri E, Romero M, Ripamonti CI, et al. Randomized trial of low-dose morphine versus weak opioids in moderate cancer pain[J]. J Clin Oncol, 2016, 34(5):436-442.
[13] Tessaro L, Bandieri E, Costa G, et al. Use of oxycodone controlled-release immediately after NSAIDs:a new approach to obtain good pain control[J]. Eur Rev Med Pharmacol Sci, 2010, 14(2):113-121.
[14] Pan H, Zhang Z, Zhang Y, et al. Efficacy and tolerability of oxycodone hydrochloride controlled-release tablets in moderate to severe cancer pain[J]. Clin Drug Investig,2007, 27(4):259-267.
[15] Tassinari D, Drudi F, Rosati M, et al. The second step of the analgesic ladder and oral tramadol in the treatment of mild to moderate cancer pain:a systematic review[J]. Palliat Med, 2011, 25(5):410-423.
[16] Leppert W. Tramadol as an analgesic for mild to moderate cancer pain[J]. Pharmacol Rep, 2009, 61(6):978-992.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |