晚期癌痛患者大剂量吗啡持续PCA泵给药转换系数的回顾性研究  

Retrospective Study on the Conversion Coefficient of High Dose of Morphine Injection Continuous PCA Pump Delivery for the Patients with Advanced Cancer Pain

作　　者：杨勇 吴励歌 刘永刚 张旭东[3] 邓涤[4] Yang Yong Wu Ligei Liu Yonggang Zhang Xudong Deng Di(Department of Oncology, China Resources ＆Wisco General Hos- pital, Wuhan 430080, China Department of Oncology, the First PeopIe~ Hospital of Jiangxia District of Wuhan The First Spe- cial Medicine Department, Northeast Pharmaceutical Group Shenyang Pharmaceutical Co. Ltd. Department of Radiotherapy and Chemotherapy, Zhongnan Hospital of Wuhan University)

机构地区：[1]华润武钢总医院肿瘤科,武汉430080 [2]武汉市江夏区第一人民医院肿瘤科 [3]东北制药集团沈阳第一制药有限公司特药部 [4]武汉大学中南医院放化疗科

出　　处：《中国药师》2017年第6期1061-1064,共4页China Pharmacist

摘　　要：目的:探讨应用大剂量阿片类药物的晚期癌痛患者转换为持续静脉泵入或持续皮下注射吗啡的转换系数。方法:采用回顾性研究方法,将需要大剂量阿片类药物镇痛但疗效欠佳的晚期癌症患者分为3∶1和2.5∶1组,分别经3∶1或2.5∶1的转换系数将阿片药物等效转换为经静脉或皮下持续注射吗啡注射剂,评估吗啡转换后患者的疼痛缓解程度、止痛有效率、转换过程中滴定次数、稳定止痛时每日等效口服吗啡总量、吗啡相关不良反应等指标,评价经不同转换系数转换后吗啡针剂的镇痛效果。结果:转换后两组患者疼痛缓解程度、止痛有效率和稳定止痛时每日等效口服吗啡总量等差异均无统计学意义(P>0.05)。两组患者吗啡调整次数分别是(1.57±0.93)和(1.00±0.00),差异有统计学意义(P<0.05)。两组主要吗啡相关不良反应均为便秘,发生率差异无统计学意义(P>0.05)。结论:需要大剂量阿片但止痛疗效欠佳的晚期癌痛患者转换为吗啡针剂,使用PCA泵经静脉或皮下持续注射可有效止痛。使用2.5∶1的转换系数可以快速完成转换后的滴定过程,安全、有效地达到有效止痛。Objective： To discuss the conversion coefficient of morphine injection with continuous intravenous pump delivery or subcutaneous injection for the patients with advanced cancer pain demanding high dose of opioids. Methods： Using a retrospective sur- vey, the patients with advanced cancer pain demanding high dose of opioids with poor efficacy were divided into 3 ： 1 group and 2.5 ： 1 group, and the conversion coefficient of 3 ： 1 or 2.5 ： 1 was used for the opioids equivalently conversed to intravenous or subcutaneous injection of morphine. After the conversion, the degree of pain relief, the analgesic efficiency in the conversion process, titration time, daily oral morphine equivalent amount at stable pain, morphine related adverse reactions and the other indicators were studied to evalu- ate the analgesic effect of morphine injection with different conversion coefficient. Results： There was no statistical significant differ- ence between the two groups in the degree of pain relief, the effective rate of analgesia and the daily oral akministration amount of mor- phine at sable pain（ P 〉 0.05 ）. The adjustment times for morphine in the two groups was （1.57 ± 0.93 ） and （1.0 ± 0.00） , respec- tively, and the difference was statistically significant （P 〈 0.05 ）. The daily oral administration amount of morphine at stable pain in the two groups respectively was （226.67 ± 69.74） mg and （258.67 ± 101.34） mg; the morphine related adverse reactions were main- ly constipation, and there was no significant difference in the incidence （ P 〉 0.05 ）. Conclusion： Giving morphine injection to the pa- tients with terminal cancer pain demanding high dose of opioids with poor effect, the use of PCA pump through intravenous or subcuta- neous injection can effectively relieve pain. Using the conversion coefficient of 2.5 ： 1 can quickly complete the titration process, and safely achieve the effective analgesia.

关 键 词：吗啡 阿片转换 转换系数 自控镇痛泵 晚期癌痛 

分 类 号：R971.2[医药卫生—药品]