造口对晚期消化道肿瘤患者镇痛模式的影响  

Effect of enterostomy on analgesic pattern in patients with advanced digestive tract cancer

作　　者：凌家瑜[1] 黎燕红[1] 钟力行 李唯伟 刘浩 蔡月[1] 胡华斌[1] 张剑威 邓艳红[1] Ling Jiayu;Li Yanhong;Zhong Lixing;Li Weiwei;Liu Hao;Cai Yue;Hu Huabin;Zhang Jianwei;Deng Yanhong(Department of Medical Oncology,The Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院肿瘤内科,广东省胃肠病学研究所,广东省结直肠盆底疾病研究重点实验室,广州510655

出　　处：《中华胃肠外科杂志》2019年第12期1159-1164,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：广州市科技计划(201803010073)。

摘　　要：目的探讨造口状态对晚期消化道肿瘤患者镇痛模式的影响。方法采用回顾性队列研究方法,本研究经中山大学附属第六医院伦理委员会审核通过(E2018026)。病例纳入标准:(1)年龄性别不限;(2)经组织学明确诊断为消化道恶性肿瘤,经过CT或者MR证实存在局部复发或转移;(3)疼痛数字评价量表(NRS)疼痛评分≥4分,需使用阿片类镇痛药物;(4)自愿签署知情同意书。排除标准:(1)早期恶性肿瘤;(2)研究者认为可能存在影响服药依从性的不良精神状态;(3)对阿片类药物超敏反应或过敏性反应。收集2016年9月至2017年4月期间于中山大学附属第六医院肿瘤科进行综合治疗的晚期消化道肿瘤患者临床资料,将患者有无进行肠造口分为造口组和无造口组,分析两组患者的临床特征,包括年龄、性别、造口状态、疼痛部位、有无肠梗阻以及疼痛特点、镇痛药物的选择、镇痛剂不良反应的处理。疼痛的评估采用简明疼痛评估量表(BPI)和NRS疼痛评分。疼痛的治疗主要为强阿片类药物;不耐受阿片类的患者首次用药进行阿片类药物滴定,滴定药物包括盐酸吗啡片、羟考酮和吗啡针。疼痛控制稳定后,换缓释制剂维持治疗,缓释制剂包括硫酸吗啡缓/控释片、盐酸羟考酮缓释片和芬太尼透皮贴。镇痛治疗效果的评价需同时满足NRS评分≤3分、爆发痛<3次/d及持续3 d以上。采用χ2检验和Wilcoxon符号秩和检验进行造口组和无造口组患者临床特征的分析,对比造口组与无造口组患者的一般临床资料、疼痛特点、镇痛药物选择和应用缓泻剂预防或治疗便秘的情况,应用多元回归模型进行多因素logistic回归分析造口状态对镇痛治疗以及缓泻剂使用的影响。结果共计123例患者符合入组条件纳入研究。男性79例,女性44例,中位年龄51岁。造口组52例,包括回肠造口30例,结肠造口22例;无造口组71例。造口组中,40例(76Objective To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer.Methods A retrospective cohort study was carried out,which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University(E2018026).Inclusion criteria were as follows:(1)age and gender were not limited;(2)all the gastrointestinal malignancies were confirmed histologically,and local recurrence or metastasis were confirmed by CT or MR;(3)numerical rating scale(NRS)≥4 points,opioid analgesic drugs were required;(4)informed consents were signed by patients of their own.Exclusion criteria were as follows:(1)malignancies of early stage;(2)suspicious adverse mental states which might lead to poor administration compliance;(3)hypersensitivity or allergic reactions to opioids.Clinical data of patients with advanced gastrointestinal cancer receiving comprehensive treatment at the Medical Oncology Department of the Sixth Affiliated Hospital of Sun Yat-sen University from September 2016 to April 2017 were retrospectively collected.The patients were divided into the stoma group and the non-stoma group.The clinical findings of two groups were analyzed,including age,sex,ostomy status,pain location,presence or absence of intestinal obstruction,pain characteristics,selection of opioid analgesic agents,treatment of side effects of analgesics.Pain was assessed using brief pain inventory(BPI)table and NRS score.Strong opioids were prescribed for patients of NRS≥4.Patients who were intolerant to opioids required opioid titration.The titration drugs included oral or IV morphine and oxycodone.After achievement of adequate pain control,long-acting opioids were administered,which included sustained-release morphine tablets,controlled release oxycodone and transdermal fentanyl.Criteria for pain relief included NRS≤3,breakthrough pain<3 times/day and duration of adequate pain control>3 days.Theχ2 test and the Wilcoxon signed rank sum test(nonparametric test)were used to analyze the clinical features

关 键 词：造口 阿片类药物 缓泻剂 镇痛模式 

分 类 号：R735[医药卫生—肿瘤]