从典型病例探讨超大剂量吗啡的管理及癌痛规范化治疗  

Exploration on management of high-dose morphine and standardized treatment of cancer pain through the typical cases

作　　者：朱亚宁[1] 周楠[1] 张鹏[1] 左燕[1] 

机构地区：[1]陕西省人民医院药学部,西安710068

出　　处：《实用药物与临床》2018年第2期202-205,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的回顾性分析2例晚期癌痛患者持续静脉泵入超大剂量吗啡镇痛的用药情况,探讨其临床应用的合理性及管理措施。方法对2例癌痛患者的疼痛性质、原因、缓解或加重因素、生活质量、PS及疼痛NRS评分进行综合评估。临床药师通过监护患者疼痛缓解情况和不良反应,对吗啡使用剂量进行动态评估和调整,同时给予辅助止痛用药合理化建议。结果持续静脉泵入超大剂量吗啡可降低患者的NRS评分,有效缓解重度顽固性癌痛。吗啡最大日剂量达1 000 mg与4 000 mg。除便秘、恶心、呕吐、嗜睡等不良反应外,2例患者均未观察到昏迷、呼吸抑制等吗啡中毒症状。结论临床药师在癌痛规范化病房全程参与了超大剂量使用阿片类药物的管理及使用工作,不仅保障了吗啡使用的可及性与安全性,还在癌痛规范化治疗中发挥了重要作用。Objective To retrospectively analyze the drug use of continuous intravenous pumping of high-dose morphine in the 2 patients with advanced cancer pain,and explore the rationality and management of morphine in clinical practice. Methods The pain nafure,causes,relief or exacerbation factors,quality of life,PS and NRS scores were comprehensively evaluated. Clinical pharmacists evaluated and adjusted the dosage of morphine dynamically,meanwhile,they gave some suggestions for the rational use of accessory analgesics. Results Continuous intravenous pumping of high-dose morphine could reduce the patients＇ NRS score and alleviate intractable severe pain effectively. The maximum daily dose of morphine was 1 000 mg and 4 000 mg in the 2 cases. Except for constipation,nausea,vomiting and lethargy,no coma,respiratory depression or other poisoning symptoms for morphine occurred. Conclusion Clinical pharmacists participate in the management and use of high-dose opoid drugs in standardized ward of cancer. It not only ensures the accessibility and safety of morphine use,but also plays an important role in standardized treatment of cancer pain.

关 键 词：超大剂量 吗啡 持续静脉泵入 癌痛 规范化治疗 

分 类 号：R95[医药卫生—药学]