癌痛规范化治疗技术推广对县域癌痛患者治疗措施及疗效的影响  

Effect of standardized treatment technology popularization on treatment measures and efficacy in cancer pain patients in county

作　　者：黄月球[1] 张凯[2] 王军伟[3] HUANG Yueqiu;ZHANG Kai;WANG Junwei(Department of Pain Management,Tiantai People′s Hospital of Zhejiang Province,Zhejiang Province,Taizhou 317200,China;Department of Oncology,Tiantai People′s Hospital of Zhejiang Province,Zhejiang Province,Taizhou 317200,China;Department of Infectious Disease,Tiantai People′s Hospital of Zhejiang Province,Zhejiang Province,Taizhou 317200,China)

机构地区：[1]浙江省天台县人民医院疼痛科,浙江台州317200 [2]浙江省天台县人民医院肿瘤科,浙江台州317200 [3]浙江省天台县人民医院感染科,浙江台州317200

出　　处：《中国医药导报》2018年第36期48-51,共4页China Medical Herald

基　　金：浙江省医药卫生科技计划项目(2015ZHB020)

摘　　要：目的探讨癌痛规范化治疗技术推广对县域癌痛患者治疗措施及疗效的影响。方法通过回顾专用病历记录资料,将2014年1月1日～2015年6月31日在浙江省天台辖区办理麻醉专用病历的癌痛病例707例(处方数106)纳入到规范化治疗前组,将2015年7月1日～2016年12月31日在浙江省天台辖区办理麻醉专用病历的癌痛病例952例(处方数857)纳入到规范化治疗后组。通过培训考核、现场指导、患者教育、专人随访、持续改进等多种形式进行癌痛规范化治疗技术推广。比较两组患者阿片类药物(吗啡针剂、吗啡片剂、盐酸羟考酮缓释片)使用量、两组医生治疗癌痛的不规范情况及患者对治疗的依从性。结果与规范化治疗前组比较,规范化治疗后组患者阿片类药物的人均口服使用量明显提高(P <0.01);规范化治疗后组患者阿片类药物人均针剂使用量,医生无指征使用针剂、评分与用药不符、首次使用阿片类药物未滴定、剂量调整不合理、未预防不良反应、爆发痛处理不规范者占比,患者服药时间不规范、用药途径不规范、不按医嘱调整剂量占比均降低,差异有高度统计学意义(P <0.01)。结论培训、考核、现场指导能提高基层医院医护人员治疗的规范性,各种形式的宣教、随访能提高癌痛患者及其家属对规范治疗的依从性,疼痛控制率大大提升,可以在很大程度上减轻患者痛苦,提高晚期肿瘤姑息治疗及居家疗养的舒适度,提高患者生活质量。Objective To explore the effect of standardized treatment technology popularization on treatment measures and efficacy in cancer pain patients in county. Methods By reviewing exclusive medical records, seven hundred and seven cancer pain cases(106 recipes) with special anesthesia records in Zhejiang Province Tiantai District from January 1, 2014 to June 31, 2015 were divided into the pre-standardized treatment group, nine hundred and fifty-two cancer pain cases(857 recipes) with special anesthesia records from July 1, 2015 to December 31, 2016 in Zhejiang Province Tiantai District were divided into the post-standardized treatment group. The methods of standardized cancer pain treatment popularization included training-examination, field guidance, education for patients, close follow-up,and continuous improvement. The opioid drugs(Morphine Injection, Morphine Tablets, Oxycodone Hydrochloride Sustained-release Tablets) usage, nonstandard condition of doctors′ treatment for cancer pain and compliance of patients to treatment between the two groups were compared. Results Compared with the pre-standardized treatment group, the per capita oral dose of opioid drugs in the post-standardized treatment group was increased(P < 0.01); the per capita in-jection dose of opioid drugs, the proportion of doctors using the injection without indication, the medication inconsistent with the score, using opioid drugs for the first time without titration, unreasonable dose adjustment, no prevention for the adverse reaction, nonstan-dard treatment of explosive pain, and the proportion of patients not taking the medicine in a standard time, not taking the medicine in a standard way, and not adjusting the dose according to the doctor’s advice were decreased, the differences were highly statiscally significant(P < 0.01). Conclusion Training, examination, filed guidance can improve the standardization of medical staff treatment in basic-level hospitals. Various forms of education and close follow-up can improve the compliance of patien

关 键 词：癌痛 规范化治疗 疗效 

分 类 号：R441.1[医药卫生—诊断学]