规范药物管理对癌痛治疗的临床和社会价值探讨
摘要
控制癌痛的药物管理是药事管理的课题之一；癌症患者所有症状中最严重的症状是疼痛。如何有效控制癌痛，探索最科学，最有效，最合理，最规范的镇痛药物应用和药物管理方法，最大限度提高癌症患者的生活质量是临床和基础研究中特别是药事管理亟待解决的实际问题。
课题研究分三部探讨规范药事管理，规范，合理用药对癌痛治疗的临床，经济和社会价值。
1．探讨癌症疼痛患者镇痛药物在合理，规范的管理下使用，有效镇痛对其癌症治疗效果，生活质量，生理和精神的影响，对208例癌症患者癌痛有效和无效止痛的精神症状包括抑郁、焦虑、失眠和自杀倾向，生理包括体重、食欲、体力等相关指标观察；结果表明视觉模拟评分法(VAS)进行量化分析镇痛前观察组评分均值为8.4±2.5，对照组为8.5±3.1，镇痛后观察组评分均值为2.8±1.7，对照组评分均值为7..8±3.6；观察组体重增加70.8%，体重不变11.2%，体重减轻18.1%；对照组体重增加18.8%，体重不变25.0%，体重下降56.2%，食欲改善，观察组和对照组分别有60.4%和14.1%；乏力缓解分别有28.1%和4.7%；生活质量的评分镇痛前观察组评分均值为30.6±7.9，对照组评分均值为31.2±11.4，镇痛后观察组为46.5±10.6，对照组评分均值为34.7±15.4；抑郁状态镇痛治疗前所有患者中33.7%表现抑郁，镇痛治疗后仅23.5%表现为抑郁症状，观察组镇痛前和镇痛后分别有20.8%和9.7%符合抑郁症诊断标准，镇痛治疗前所有患者中24.0%有焦虑症状，镇痛后仅13.9%有焦虑症状，镇痛前后观察组有22.9%和9.4%表现为焦虑症状，对照组镇痛前后分别有28.1%和25.0%表现为焦虑症状；睡眠状况的影响所有患者19.2%睡眠改善，其中观察组36.1%，对照组12.5%，有效止痛对体重、食欲、体力及缓解抑郁、焦虑、睡眠障碍均改善；两组相比均有统计学意义。提出癌症患者应用止痛药物是一项特殊的药事管理内容。
2．采用国内多中心临床调研，探讨分析目前国内对癌症患者镇痛药物治疗应用管理的现状，研究通过调研分析国内5家肿瘤诊治中心癌症患者对镇痛治疗所采用的方案及效果，结果，规范应用镇痛（三阶梯，定时，定量）仅占调查病例的29.5%；与非规范镇痛治疗（病人主观意愿为用药依据）占70.5%。并对镇痛效果及不良反应，药物用量和费用等情况进行对照研究，应用规范治疗总有效率达97.6%，非规范治疗总有效率为81.7%；两组显著有效率为89.2%和32.8%，差异有统计学意义；治疗费用两组比较无统计学差异，结论规范治疗方案能更有效的缓解癌症疼痛。提出癌痛控制最佳药物管理方案。
3．建立了胰腺癌腹膜后转移的裸鼠癌痛动物模型，模拟胰腺癌患者腹膜后神经转移引起癌痛的晚期病变状态，动物模型建立后，随机分为两组，一组给以镇痛药物，另一组为对照组，观察积极和有效的癌痛控制对动物食欲、体重、肿瘤生长、生存时间的影响；证实积极的癌痛控制能明显改善动物食欲，保持或增加体重，对肿瘤生长有抑制作用，延长平均生存时间。
本课题采用临床对照和动物实验相结合的方法，证实了癌症患者癌痛控制及规范合理用药管理的社会价值和临床价值，提出了针对癌症疼痛用药的药事管理的特殊性和管理策略。
Drug management for cancer pain is the pharmacy administration. Study focus onthe methods of scientific, effective, reasonable, and standard analgesic drugapplication
This study included three parts1. Study on standard method and impact oneffectiveness of quality of life, physical and psychological activities.208cases wereobserved, including the quality of life psychiatric symptoms including depressionanxiety insomnia and suicidal tendencies physiological symptoms including weightappetite and physical strength.The results showed that the average of visual analogscale (VAS) for the quantitative analysis of analgesic score was8.4±2.5and8.5±3.1in the observation group and control group before analgesia, and2.8±1.7and7.8±3.6after analgesia; the body weight was increased, unchanged, and decreased was70.8%,11.2%,18.1%and18.8%,25.0%56.2%of patients in the observation andcontrol group, respectively; the appetite was improved in60.4%and14.1%for theobservation and control group; the fatigue alleviate was28.1%and4.7%, respectively;the average score of quality of life was30.6±7.9and31.2±11.4, and46.5±10.6and34.7±15.4in the observation and control group before and after analgesia;33.7%ofall patients presented with manifestations of depression before and only23.5%afteranalgesia;20.8%of patients in the observation group met the diagnostic criteria ofdepression before and9.7%after analgesia;24.0%of all patients presented withsymptoms of anxiety before and only13.9%after analgesia;22.9%of patients in theobservation group presented with anxiety before and9.4%after analgesia;28.1%ofpatients in the control group presented with anxiety before and25.0%after analgesia;the sleep status was improved in19.2%of all patients,36.1%in the observation and12.5%in the control group; Analgesia can improve the quality of life of patients withcancer, alleviate depression, anxiety, sleep disorders, suicidal tendencies, andincrease appetite and body weight; there was significant difference between the twogroups. The study proposes is that the application of analgesic drug for cancer is aspecial subject in pharmacy administration.
2. By using multi-center clinical investigation study the current situation ofanalgesic drug application for cancer pain
1000patients of cancer pain were investigated in five Cancer Centers. The results showed that those patients with standardized application of analgesia (three steps,timing, quantitative) accounted only29.5%of investigated cases, and those withnon-normative analgesia (based on patients symptoms) accounted for70.5%. the totaleffective rate were97.6%and81.7%for standardized and non-normative treatmentgroup; the significant effective rate were89.2%and32.8%for standardized andnon-normative treatment group with statistical significance; there was no statisticallysignificant differences between two groups about treatment cost. We conclude that astandard treatment program is more effective for cancer pain relief and propose thebest drug management programs for cancer pain control.
3. Establish a cancer pain animal model the animals were divided into two groups,one given analgesic drugs and the others as control. By an observation of appetite,body weight tumor growth and survival time. Study confirmed that pain control cansignificantly improve the animal appetite maintain or increase body weight inhibittumor growth, and prolong the survival time.
Study confirmed that the cancer pain control and rational drug management hasthe social and clinical significances. the pharmacy administration and managementstrategy play an very important role in cancer pain medication.
课题研究分三部探讨规范药事管理，规范，合理用药对癌痛治疗的临床，经济和社会价值。
1．探讨癌症疼痛患者镇痛药物在合理，规范的管理下使用，有效镇痛对其癌症治疗效果，生活质量，生理和精神的影响，对208例癌症患者癌痛有效和无效止痛的精神症状包括抑郁、焦虑、失眠和自杀倾向，生理包括体重、食欲、体力等相关指标观察；结果表明视觉模拟评分法(VAS)进行量化分析镇痛前观察组评分均值为8.4±2.5，对照组为8.5±3.1，镇痛后观察组评分均值为2.8±1.7，对照组评分均值为7..8±3.6；观察组体重增加70.8%，体重不变11.2%，体重减轻18.1%；对照组体重增加18.8%，体重不变25.0%，体重下降56.2%，食欲改善，观察组和对照组分别有60.4%和14.1%；乏力缓解分别有28.1%和4.7%；生活质量的评分镇痛前观察组评分均值为30.6±7.9，对照组评分均值为31.2±11.4，镇痛后观察组为46.5±10.6，对照组评分均值为34.7±15.4；抑郁状态镇痛治疗前所有患者中33.7%表现抑郁，镇痛治疗后仅23.5%表现为抑郁症状，观察组镇痛前和镇痛后分别有20.8%和9.7%符合抑郁症诊断标准，镇痛治疗前所有患者中24.0%有焦虑症状，镇痛后仅13.9%有焦虑症状，镇痛前后观察组有22.9%和9.4%表现为焦虑症状，对照组镇痛前后分别有28.1%和25.0%表现为焦虑症状；睡眠状况的影响所有患者19.2%睡眠改善，其中观察组36.1%，对照组12.5%，有效止痛对体重、食欲、体力及缓解抑郁、焦虑、睡眠障碍均改善；两组相比均有统计学意义。提出癌症患者应用止痛药物是一项特殊的药事管理内容。
2．采用国内多中心临床调研，探讨分析目前国内对癌症患者镇痛药物治疗应用管理的现状，研究通过调研分析国内5家肿瘤诊治中心癌症患者对镇痛治疗所采用的方案及效果，结果，规范应用镇痛（三阶梯，定时，定量）仅占调查病例的29.5%；与非规范镇痛治疗（病人主观意愿为用药依据）占70.5%。并对镇痛效果及不良反应，药物用量和费用等情况进行对照研究，应用规范治疗总有效率达97.6%，非规范治疗总有效率为81.7%；两组显著有效率为89.2%和32.8%，差异有统计学意义；治疗费用两组比较无统计学差异，结论规范治疗方案能更有效的缓解癌症疼痛。提出癌痛控制最佳药物管理方案。
3．建立了胰腺癌腹膜后转移的裸鼠癌痛动物模型，模拟胰腺癌患者腹膜后神经转移引起癌痛的晚期病变状态，动物模型建立后，随机分为两组，一组给以镇痛药物，另一组为对照组，观察积极和有效的癌痛控制对动物食欲、体重、肿瘤生长、生存时间的影响；证实积极的癌痛控制能明显改善动物食欲，保持或增加体重，对肿瘤生长有抑制作用，延长平均生存时间。
本课题采用临床对照和动物实验相结合的方法，证实了癌症患者癌痛控制及规范合理用药管理的社会价值和临床价值，提出了针对癌症疼痛用药的药事管理的特殊性和管理策略。
Drug management for cancer pain is the pharmacy administration. Study focus onthe methods of scientific, effective, reasonable, and standard analgesic drugapplication
This study included three parts1. Study on standard method and impact oneffectiveness of quality of life, physical and psychological activities.208cases wereobserved, including the quality of life psychiatric symptoms including depressionanxiety insomnia and suicidal tendencies physiological symptoms including weightappetite and physical strength.The results showed that the average of visual analogscale (VAS) for the quantitative analysis of analgesic score was8.4±2.5and8.5±3.1in the observation group and control group before analgesia, and2.8±1.7and7.8±3.6after analgesia; the body weight was increased, unchanged, and decreased was70.8%,11.2%,18.1%and18.8%,25.0%56.2%of patients in the observation andcontrol group, respectively; the appetite was improved in60.4%and14.1%for theobservation and control group; the fatigue alleviate was28.1%and4.7%, respectively;the average score of quality of life was30.6±7.9and31.2±11.4, and46.5±10.6and34.7±15.4in the observation and control group before and after analgesia;33.7%ofall patients presented with manifestations of depression before and only23.5%afteranalgesia;20.8%of patients in the observation group met the diagnostic criteria ofdepression before and9.7%after analgesia;24.0%of all patients presented withsymptoms of anxiety before and only13.9%after analgesia;22.9%of patients in theobservation group presented with anxiety before and9.4%after analgesia;28.1%ofpatients in the control group presented with anxiety before and25.0%after analgesia;the sleep status was improved in19.2%of all patients,36.1%in the observation and12.5%in the control group; Analgesia can improve the quality of life of patients withcancer, alleviate depression, anxiety, sleep disorders, suicidal tendencies, andincrease appetite and body weight; there was significant difference between the twogroups. The study proposes is that the application of analgesic drug for cancer is aspecial subject in pharmacy administration.
2. By using multi-center clinical investigation study the current situation ofanalgesic drug application for cancer pain
1000patients of cancer pain were investigated in five Cancer Centers. The results showed that those patients with standardized application of analgesia (three steps,timing, quantitative) accounted only29.5%of investigated cases, and those withnon-normative analgesia (based on patients symptoms) accounted for70.5%. the totaleffective rate were97.6%and81.7%for standardized and non-normative treatmentgroup; the significant effective rate were89.2%and32.8%for standardized andnon-normative treatment group with statistical significance; there was no statisticallysignificant differences between two groups about treatment cost. We conclude that astandard treatment program is more effective for cancer pain relief and propose thebest drug management programs for cancer pain control.
3. Establish a cancer pain animal model the animals were divided into two groups,one given analgesic drugs and the others as control. By an observation of appetite,body weight tumor growth and survival time. Study confirmed that pain control cansignificantly improve the animal appetite maintain or increase body weight inhibittumor growth, and prolong the survival time.
Study confirmed that the cancer pain control and rational drug management hasthe social and clinical significances. the pharmacy administration and managementstrategy play an very important role in cancer pain medication.
引文
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