809例晚期癌痛患者阿片耐受性及量化分析方法研究  

STUDY ON OPIOID TOLERANCE AND THE METHODS OF QUANTITATIVE ANALYSIS IN 809 CASES OF PAIN WITH TERMINAL CANCER

作　　者：薛钧[1] 刘晓铭 刘晶煜[1] 朱婷[1] 李文娟[1] 陈梅林[1] 

机构地区：[1]兰州大学第二医院宁养院,兰州730030 [2]甘肃省第二人民医院精神卫生科,兰州730030

出　　处：《中国疼痛医学杂志》2014年第4期236-240,共5页Chinese Journal of Pain Medicine

摘　　要：目的：研究阿片类药物在晚期癌痛治疗中的耐受性趋势并探索其量化分析方法.方法：利用阿片类药物的耐受性与患者服用阿片类药的总剂量（不同种类阿片类药的剂量采用吗啡等效剂量简称吗啡当量）及增加剂量的差值呈正相关,而与用药时长呈负相关这一基本原理对809例晚期癌痛患者的相关用药数据进行分析研究,设计出可行的阿片耐受性量化指标—阿片耐受指数的计算公式.对比所得数值,并分析其变化趋势.结果：809例晚期癌痛患者中有498例呈现明显的耐受趋势,阿片耐受指数在1.86～5.82之间.不同病种之间的平均耐受指数有显著差异;不同性别间无明显差异;芬太尼贴剂对比口服吗啡或羟考酮缓释剂的平均耐受指数有高度显著性差异.结论：根据作者所设计的阿片耐受指数计算公式所计算出的结果能基本准确指示出个体患者在应用阿片类药物时所产生耐受差异的程度.利用这一数值可以比较直观地对比不同个体、不同病种、不同性别及不同阿片类药物等因素之间的耐受性程度的差异.这一量化指标对晚期癌痛治疗中阿片类药物、药量及治疗方法的选择及相关研究具有指导意义.Objective：To investigate the trend of opioid tolerance in cancer pain patients with opioids treatment in Hospice and to explore its quantitative evaluation measures.Methods：Data from 809 cancer patients with persistent pain were collected and opioid tolerance index （OTI） was calculated.Predictors of OTI were analyzed accordingly.Results：Opioid tolerance was presented in 498 cases of the 809 patients with persistent pain and their OTI ranged from 1.86 to 5.82.A significant difference was shown in OTI between different tumors.In comparison between fentanyl patch with morphine or oxycodone,a highly significant difference was found.Conclusion：The individual tolerance degree can be predicted by the OTI value.By using this index,comparison can be directly made dealing with the diversity of tolerance degree between different individuals,different tumors and different opioids.This quantitative evaluation may have some value in choosing analgesics,opioid dosage and analgesic regimes in the treatment of terminal cancer pain.

关 键 词：吗啡当量 晚期癌痛 阿片耐受 阿片耐受指数 

分 类 号：R730.5[医药卫生—肿瘤]