低剂量芬太尼透皮贴对中重度癌痛患者的镇痛效果观察
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摘要
目的探讨低剂量芬太尼透皮贴(TDF)对中重度癌痛患者的镇痛效果及其不良反应。方法选择中、重度癌痛共68例患者,分为中度疼痛组(n=37)与重度疼痛组(n=31),两组均采用低剂量TDF(12.5μg/h)镇痛治疗,观察镇痛效果及患者不良反应发生情况。结果两组性别、年龄、肿瘤转移情况、既往治疗和肿瘤类型等一般资料比较无统计学差异(P <0.05);治疗后,两组疼痛NRS评分均明显下降(P <0.05);与中度疼痛组相比,重度疼痛组降低幅度更大(P <0.05);两组治疗期间不良反应发生率比较无明显差异(P> 0.05)。结论低剂量TDF是一种有效的控制中、重度癌症疼痛的治疗方式,且不良反应少。建议对于中重度癌症疼痛患者的镇痛治疗,以12.5μg/h作为TDF的起始剂量。
Objective To explore the analgesic effect and adverse reactions of low-dose transdermal fentanyl(TDF) patch in patients with moderate to severe cancer pain. Methods A total of 68 patients with moderate to severe cancer pain were divided into a moderate pain group(n=37) and a severe pain group(n=31). Both groups were treated with low-dose TDF(12.5 μg/h). The analgesic effect and the occurrence of adverse reactions were observed. Results There was no significant difference in gender, age, metastasis of tumors, past treatment and types of tumors between the two groups. After the treatment, the NRS scores of pain in both groups decreased significantly(P < 0.05); compared with the moderate pain group, the severe pain group decreased more significantly(P <0.05); there was no significant difference in the incidence of adverse reactions between the two groups during the treatment(P > 0.05).Conclusion Low-dose TDF is an effective way to control moderate to severe cancer pain, with fewer adverse reactions. It is suggested that the initial dose of TDF should be 12.5 μg/h for the analgesic treatment of moderate to severe cancer pain.
Objective To explore the analgesic effect and adverse reactions of low-dose transdermal fentanyl(TDF) patch in patients with moderate to severe cancer pain. Methods A total of 68 patients with moderate to severe cancer pain were divided into a moderate pain group(n=37) and a severe pain group(n=31). Both groups were treated with low-dose TDF(12.5 μg/h). The analgesic effect and the occurrence of adverse reactions were observed. Results There was no significant difference in gender, age, metastasis of tumors, past treatment and types of tumors between the two groups. After the treatment, the NRS scores of pain in both groups decreased significantly(P < 0.05); compared with the moderate pain group, the severe pain group decreased more significantly(P <0.05); there was no significant difference in the incidence of adverse reactions between the two groups during the treatment(P > 0.05).Conclusion Low-dose TDF is an effective way to control moderate to severe cancer pain, with fewer adverse reactions. It is suggested that the initial dose of TDF should be 12.5 μg/h for the analgesic treatment of moderate to severe cancer pain.
引文
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[2] Meuser T, Pietruck C, Radbruch L, et al. Symptoms during cancer pain treatment following WHO-guidelines:a longitudinal follow-up study of symptom prevalence, severity and etiology[J].Pain, 2001, 93(3):247-257.
[3] Kaasa S. Is cancer pain control improved by a simple WHO pain analgesic ladder approach combined with tumor-directed treatment[J]? J Clin Oncol, 2016, 34(5):399-400.
[4] Ripamonti CI, Santini D, Maranzano E,et al. Management of cancer pain:ESMO Clinical Practice Guidelines[J]. Ann Oncol,2012, 23(Suppl 7):vii139-154.
[5] Bista SR, Haywood A, Hardy J, et al. Exposure to fentanyl after transdermal patch administration for cancer pain management[J].J Clin Pharmacol, 2016, 56(6):705-713.
[6] Vielvoye-Kerkmeer AP, Mattern C, Uitendaal MP. Transdermal fentanyl in opioid-naive cancer pain patients:an open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naive patients and a group using codeine[J]. J Pain Symptom Manage, 2000, 19(3):185-192.
[7] Minami S, Kijima T, Nakatani T, et al. Opioid switch from low dose of oral oxycodone to transdermal fentanyl matrix patch for patients with stable thoracic malignancy-related pain[J]. BMC Palliat Care, 2014, 13:46.
[8] Hoya Y, Okamoto T, Yanaga K. Evaluation of analgesic effect and safety of fentanyl transdermal patch for cancer pain as the first line[J]. Support Care Cancer, 2010, 18(6):761-764.
[9] Mercadante S, Porzio G, Ferrera P, et al. Low doses of transdermal buprenorphine in opioid-naive patients with cancer pain:a 4-week, nonrandomized, open-label, uncontrolled observational study[J]. Clin Ther, 2009, 31(10):2134-2138.