吗啡及吗啡联合右美沙芬镇痛疗效比较  

Comparison of analgesic effect of morphine alone and combination of morphine with dextromethmorphan

作　　者：聂鋆[1] 谢广茹[2] 刘淑俊[1] 戴玲[1] 徐国柱[3] 

机构地区：[1]北京大学临床肿瘤学院,北京肿瘤医院暨北京市肿瘤防治研究所内科,北京100036 [2]天津医科大学附属肿瘤医院,天津市肿瘤医院中西医结合科,天津300060 [3]北京大学中国药物依赖性研究所临床药理研究室,北京100083

出　　处：《肿瘤》2008年第6期528-531,共4页Tumor

摘　　要：目的:规范即释吗啡剂量滴定方法及应用右美沙芬对吗啡的增效作用。方法:选择86例重度癌痛患者,试验分为吗啡滴定阶段和随机双盲对照试验阶段。吗啡滴定阶段:吗啡剂量从5 mg/4 h 1次开始,出现爆发痛时给予吗啡解救治疗,解救剂量为当日吗啡总剂量的10%,直至疼痛稳定;随机双盲对照阶段:在吗啡滴定至疼痛稳定后,将所有吗啡剂量减量30%,加用右美沙芬或其模拟片(剂量比为1∶1),再次进行剂量滴定,至疼痛稳定。结果:滴定阶段:药物剂量于第4天达到稳定并以稳定的剂量持续用药。镇痛剂量最小为30 mg,最大为160 mg。患者的疼痛强度自第3天开始明显减弱并保持稳定,生活质量明显改善;对照试验阶段:2组患者的吗啡总用量均有所减少,加右美沙芬组的减药量略多于对照组,但2组间没有差异,疼痛强度在治疗期间均保持稳定。结论:规范的即释吗啡剂量滴定方法镇痛效果满意,加用右美沙芬有减少吗啡用药总量的趋势。Objective： To standardize the method for morphine dose titration and investigate the synergistic effect of dextromethorphan with morphine on cancer pain. Methods： Eighty six adult patients with severe cancer pain were selected. The experiment was divided into two stages： the stage of morphine dose titration and random double-blind contrast test. At the stage of morphine dose titra- tion the patients were administered morphine 5 mg/4 h at baseline and given ＂as needed＂ morphine palliative treatment at 10% total daily dosage when abrupt pain occurred till the patients gained stable pain. At the stage of random double-blind contrast test the dosage of morphine was reduced by 30% and dextromethorphan or its analogue tablets （ dose ratio 1 ： 1 ） was added. Morphine dose titration was performed again till pain relief. Results： During the stage of morphine dose titration the dose of morphine was increased from the second day. The dose of morphine was stabilized on the fourth day. Morphine was given to the patients at the stable dose continuously. The minimum pain-relieving dose of morphine was 30 mg and the maximum dose was 160 mg. The pain intensity of the patients began weaker from the third day and kept stable during the treatment. The life qualities of the patients were obviously improved. During contrast test stage the total dose of morphine was reduced in beth groups. The dose of morphine was reduced a little more after addition of dextromethorphan compared with the control group. But there was no significant difference between the two groups. The pain intensity kept stabilized during the treatment. Conclusion： Standardized morphine dose titration achieved satisfactory effects on cancer pain. Addition of dextromethorphan tended to reduce the total dose of morphine.

关 键 词：吗啡 右美沙芬 镇痛药 阿片类 

分 类 号：R730.53[医药卫生—肿瘤]