预防性服用一线缓泻剂防治阿片类镇痛药物相关便秘的临床疗效  

Clinical efficacy of prophylactic medication with first-line laxatives for prevention and treatment of opioid induced constipation

作　　者：刘秋霞[1] 孙彩萍[1] 陈遐林[1] 徐俊[2] 王建芳[1] LIU Qiuxia;SUN Caiping;CHEN Xialin;XU Jun;WANG Jianfang(Department of Chemotherapy Oncology,Shaoxing People's Hospital-Shaoxing Hospital,Zhejiang University School of Medicine,Shaoxing 312000,China;Department of Radiotherapy Oncology,Shaoxing People's Hospital-Shaoxing Hospital,Zhejiang University School of Medicine,Shaoxing 312000,China)

机构地区：[1]浙江省绍兴市人民医院-浙江大学绍兴医院肿瘤内科,绍兴312000 [2]浙江省绍兴市人民医院-浙江大学绍兴医院放疗科,绍兴312000

出　　处：《中国临床药学杂志》2019年第2期97-101,共5页Chinese Journal of Clinical Pharmacy

基　　金：浙江省医药卫生科研面上项目(编号2018KY832)

摘　　要：目的证实一线缓泻剂对药物相关便秘(OIC)的预防作用,探讨"单药预防,双药治疗"OIC防治模式的有效性及安全性。方法收集初次接受阿片类药物镇痛治疗的恶性肿瘤患者69例,分为预防组和治疗组。预防组在口服吗啡第1天的同时给予聚乙二醇4000,直到出现OIC后加用比沙可啶;治疗组在口服吗啡时不予预防性用药,直到出现OIC,给予聚乙二醇4000及比沙可啶,即按需给药。疗程均为14 d。比较2组间客观OIC发生率、主观OIC发生率、肠功能指数(BFI)和便秘患者生活质量(PAC-QoL)及不同剂量亚组间的差异。结果 59例结果可供分析,其中预防组29人,治疗组30人。预防组和治疗组客观OIC发生率分别为34.6%和63.3%(P<0.05),主观OIC发生率分别为37.9%及66.7%(P<0.05)。吗啡治疗第8天及第15天预防组BFI分值均较治疗组显著降低,P值分别为0.044和0.042,差异主要体现在中、小剂量亚组。第15天PAC-QoL分值2组间总体无差异。亚组分析中小剂量组中预防组PAC-QoL低于治疗组,P=0.021。2组间不良反应发生率差异无统计学意义。结论预防性口服聚乙二醇4000安全有效,"单药预防,双药治疗"的OIC防治模式,能减少服用较小剂量阿片类药物癌痛患者的OIC发生率,减轻相关症状,提高了生活质量。AIM To investigate the preventive effect of first-line laxatives and explore the efficacy and safety of the pattern for the prevention and treatment of opioids induced constipation( OIC) as ‘Single drug for preven-tion,two for treatment’. METHODS Eligible in-patients were assigned to prevention group and treatment group. In prevention group,poly ethylene glycol 4000 was prescribed daily,together with opioids treatment at day 1 for 14 days,bisacodyl was prescribed as needed. In treatment group,no preventative medicine was prescribed until OIC occurred,then poly ethylene glycol 4000 plus bisacodyl was given as needed. Objective OIC incidence,sub-jective OIC incidence,bowel function index( BFI) and patients assessments of constipation quality of life ( PAC-QoL) between 2 groups were compared. Furthermore,the differences between the subgroups were also evaluated. RESULTS A total of 59 patients,29 in the prevention group and 30 in the treatment group were evaluable. The objective OIC incidence was 34. 6% and 63. 3%,while the subjective OIC incidence was 37. 9% and 66. 7% for the prevention group and treatment group respectively,and the OIC incidence in prevention group was lower than that of the treatment group( P < 0. 05). The improvement of BFI in prevention group was significant at day 8 and day 15,P = 0. 044 and 0. 042 respectively,and the difference was mainly reflected in medium and low dose subgroups. The 2 groups had no differences in PAC-QoL at day15,but subgroup analysis indicated PAC-QoL value of prevention group was better than treatment group in medium-low dose subgroups,P = 0. 021. There were no differences in incidence of adverse drug reactions between 2 groups. CONCLUSION Preventive use of poly ethylene glycol 4000 is effective and tolerability,‘Single drug for prevention,two for treatment’measure for the prevention and treatment of OIC can reduce OIC incidence,relieve related symptom and improve quality of life.

关 键 词：癌痛 阿片类药物相关性便秘 缓泻剂 预防性给药 

分 类 号：R730.5[医药卫生—肿瘤]