硫酸吗啡控释片联合塞来昔布个体化治疗中重度癌痛的临床疗效及安全性  

An evaluation on effect and safety of morphine sulfate controlled-release tablet combined with celecoxib for the treatment of moderate to severe cancer-induced pain

作　　者：蔡讯[1] 薛鹏[1] 宋卫峰[1] 王理伟[1] 

机构地区：[1]上海交通大学附属第一人民医院肿瘤科,上海200080

出　　处：《中国癌症杂志》2009年第4期270-273,共4页China Oncology

摘　　要：背景与目的:疼痛是中晚期肿瘤患者最常见的症状之一,吗啡是控制中、重度癌痛的代表药物,但部分患者由于不可耐受的不良反应而限制了其使用。本研究探讨硫酸吗啡控释片联合塞来昔布治疗中、重度癌痛的临床疗效,评价用药安全性和患者生活质量改善情况。方法:回顾性分析125例中、重度癌痛患者,一组(n=67)以硫酸吗啡控释片20mg/12h为起始剂量,24～48h后评价并进行个体剂量滴定,按50%递增或25%递减剂量直至达到维持剂量;另一组(n=58)采用相同起始剂量24～48h后评价,再加用塞来昔布200mg/12h,若疼痛不缓解则增加至400mg/12h,疼痛仍不缓解则增加硫酸吗啡控释片剂量直至维持剂量,并分析联合用药的临床疗效、剂量调整情况、药物不良反应以及患者生活质量的改善情况。结果:硫酸吗啡控释片组维持剂量的平均值为67.3mg/d,联合用药组为51.3mg/d,平均用药量减少23.77%。联合用药组与硫酸吗啡控释片组镇痛效果相同,但在便秘、恶心呕吐、嗜睡、排尿困难和头晕等不良反应上较硫酸吗啡控释片组分别减少42.25%、47.50%、11.23%、61.61%和23.01%,其中便秘和恶心呕吐两组间差异有显著性(P分别为0.028和0.046)。两组患者的生活质量均有所改善。结论:硫酸吗啡控释片联合塞来昔布能有效控制中、重度癌痛,提高晚期肿瘤患者的生活质量,并可减少吗啡用量,从而减轻吗啡的不良反应。Background and purpose： Pain is one of the most common symptoms in advanced cancer patients, and morphine is a representative drug in controlling moderate to severe cancer-induced pain, but some unacceptable adverse effects limited its use in part of patients.We evaluated the effect and safety of morphine sulfate controlled-release tablet （MS-CRT） combined with celecoxib for the treatment of moderate to severe cancer pain, and assessed the life quality of patients. Methods： Retrospective analysis of 125 cancer patients with moderate to severe cancer pain who were divided into two groups, one（including 67 patients） was treated by single drug of MS- CRT whose initial dosage was 20 mg/12 hrs, then evaluated by verbal rating scale within 24 to 48 hrs, dosage was adjusted personally according to the state of pain （increasing rate was 50% and declining rate was 25%） until the maintenance dosage was reached; the other（including 58 patients） was treated by MS-CRT with the same initial dosage and combined with celecoxib whose dosage was 200 mg/12 hrs at first, and increased to 400 rag/12 hrs if the pain was not relieved well, then gradually increased the dosage of MS-CRT to the maintenance dosage, and analyzed the effect, dose adjustment,side effect of drug combination and improvement of quality of life for the patients. Results： The mean of maintenance dosage for MS-CRT alone was 67.3 mg/day, and for the combination of MS-CRT and celecoxib was 51.3 mg/day, the reduction rate of MS-CRT in the drug combination group compared with MS-CRT alone was 23.77% with the same analgesia effect, and the incidence of side effects such as constipation and nausea/vomiting was statistically reduced compared with the single drug group. The quality of life in both groups was improved after treatment. Conclusion： The combination of MS-CRT and celecoxib can effectively control moderate to severe cancer pain,, improve the quality of life in advanced cancer patients, and reduce the consumption of MS-CRT with similar sid

关 键 词：硫酸吗啡 塞来昔布 个体化 癌痛 

分 类 号：R730.9[医药卫生—肿瘤]