临床药师在癌痛规范化治疗中干预效果评价
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摘要
目的调查癌痛药物使用情况并评价临床药师干预在癌痛治疗中的作用。方法建立临床药师指导小组(CPGTs),制定癌痛规范化处理实施细则,利用院内HIS系统软件动态监测采集肿瘤中心患者诊疗情况及癌痛用药等各项信息,选取124例患者并随机分为2组进行病例对照研究。临床药师干预组由CPGTs对癌痛患者进行评估、监测及用药指导咨询,并收集治疗的各种参数进行综合分析。结果 2014-2016年肿瘤中心非甾体类药品用量逐年增加,以塞来昔布为主,增长达52.5%,弱阿片用药逐渐减少;强阿片药品的总吗啡使用量逐年上升,以羟考酮为主,其每片10 mg和每片40 mg规格分别增长45.8%和66.8%,而芬太尼则逐渐降低;人均吗啡使用量从402.4 mg增加到506.1mg,口服/非口服比也从1.7提高到3.1。在临床药师干预的研究中,与对照组相比,干预组的癌痛治疗更规范,其疼痛评估更完善,剂量滴定更准确,而不规范的处理更少,在疼痛有效缓解的同时胃肠反应也更低(P<0.01),患者总体的生活质量得到明显改善。结论临床药师干预对癌痛治疗规范化具有积极的作用,进而改善癌痛患者生活质量。
AIM To investigate the use of analgesic drugs and evaluate the role of clinical pharmacist intervention in the treatment of cancer pain. METHODS By establishing CPGTs(clinical pharmacist-led guidance teams), the rules for standardized treatment of cancer pain and by using HIS system, the analgesic drug consumption was monitored. Meanwhile,124 patients were randomly divided into 2 groups and conducted a case control study.The clinical pharmacists provided pre-therapy consultation to physicians, monitored prescriptions during treatment and conducted patient follow-up in cancer pain therapy. The outcome parameters of therapy were collected and statistically analyzed. RESULTS From 2014 to 2016, celecoxib was the largest use and increased by 52.5% in non-steroidal anti-inflammatory drug, while the consumption of weak opioid analgesics was decreased. In strong opioid analgesics, oxycodone was the largest use, the two different doses(10 mg and 40 mg) were increased by 45.8% and 66.8% respectively, whereas fentanyl were decreased. The per person-morphine usage increased from 402.4 mg to 506.1 mg, and the ratio of non-oral to oral was 1.7 raised to 3.1. It was showed that the CPGTs could improve standardization of opioid administration. Compared with the control group, there were more frequent pain evaluation, more standardized dosing titration and less nonstandard treatmen in the intervention group. The pain relief was significantly improved and the incidences of gastrointestinal adverse events were significantly lower in the intervention group(P<0.01). CONCLUSION The intervention of clinical pharmacists has positive effect on standardization of cancer pain treatment. The clinical pharmacists play the positive role in drug use and improving the quality of life of cancer patients.
AIM To investigate the use of analgesic drugs and evaluate the role of clinical pharmacist intervention in the treatment of cancer pain. METHODS By establishing CPGTs(clinical pharmacist-led guidance teams), the rules for standardized treatment of cancer pain and by using HIS system, the analgesic drug consumption was monitored. Meanwhile,124 patients were randomly divided into 2 groups and conducted a case control study.The clinical pharmacists provided pre-therapy consultation to physicians, monitored prescriptions during treatment and conducted patient follow-up in cancer pain therapy. The outcome parameters of therapy were collected and statistically analyzed. RESULTS From 2014 to 2016, celecoxib was the largest use and increased by 52.5% in non-steroidal anti-inflammatory drug, while the consumption of weak opioid analgesics was decreased. In strong opioid analgesics, oxycodone was the largest use, the two different doses(10 mg and 40 mg) were increased by 45.8% and 66.8% respectively, whereas fentanyl were decreased. The per person-morphine usage increased from 402.4 mg to 506.1 mg, and the ratio of non-oral to oral was 1.7 raised to 3.1. It was showed that the CPGTs could improve standardization of opioid administration. Compared with the control group, there were more frequent pain evaluation, more standardized dosing titration and less nonstandard treatmen in the intervention group. The pain relief was significantly improved and the incidences of gastrointestinal adverse events were significantly lower in the intervention group(P<0.01). CONCLUSION The intervention of clinical pharmacists has positive effect on standardization of cancer pain treatment. The clinical pharmacists play the positive role in drug use and improving the quality of life of cancer patients.
引文
[1] MARCUS D A.Epidemiology of cancer pain[J].Curr Pain Headache Rep,2011,15(4):231.
[2] IMANAKA K,TOMINAGA Y,ETROPOLSKI M,et al.Efficacy and safety of oral tapentadol extended release in Japanese and Korean patients with moderate to severe,chronic malignant tumor-related pain[J].Curr Med Res Opin,2013,29(10):1399.
[3] NCCN.org.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Adult Cancer Pain[M].Version 2.2012.National Comprehensive Cancer Network,2012:35-36.
[4] 癌症疼痛诊疗规范(2011年版)[J].中华危重症医学杂志(电子版),2012,5(1):31.
[5] 李倩,罗健.阿片类药物治疗慢性中、重度癌痛研究进展[J].中国疼痛医学杂志,2011,17(2):116.
[6] CHEN J,LU X Y,WANG W J,et al.Impact of a clinical pharmacist-led guidance team on cancer pain therapy in China:a prospective multicenter cohort study[J].J Pain Symptom Manage,2014,48(4):500.
[7] SCHMIDT-HANSEN M,BENNETT M I,HILGART J.Oxycodone for cancer pain in adult patients[J].JAMA,2015,314(12):1282.
[8] KING S J,REID C,FORBES K,et al.A systematic review of oxycodone in the management of cancer pain[J].Palliat Med,2011,25(5):454.
[2] IMANAKA K,TOMINAGA Y,ETROPOLSKI M,et al.Efficacy and safety of oral tapentadol extended release in Japanese and Korean patients with moderate to severe,chronic malignant tumor-related pain[J].Curr Med Res Opin,2013,29(10):1399.
[3] NCCN.org.NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Adult Cancer Pain[M].Version 2.2012.National Comprehensive Cancer Network,2012:35-36.
[4] 癌症疼痛诊疗规范(2011年版)[J].中华危重症医学杂志(电子版),2012,5(1):31.
[5] 李倩,罗健.阿片类药物治疗慢性中、重度癌痛研究进展[J].中国疼痛医学杂志,2011,17(2):116.
[6] CHEN J,LU X Y,WANG W J,et al.Impact of a clinical pharmacist-led guidance team on cancer pain therapy in China:a prospective multicenter cohort study[J].J Pain Symptom Manage,2014,48(4):500.
[7] SCHMIDT-HANSEN M,BENNETT M I,HILGART J.Oxycodone for cancer pain in adult patients[J].JAMA,2015,314(12):1282.
[8] KING S J,REID C,FORBES K,et al.A systematic review of oxycodone in the management of cancer pain[J].Palliat Med,2011,25(5):454.