中医药联合“WHO三阶梯方案”对强阿片类药剂量、间隔与副作用影响回顾与展望  

Review and Prospect of Influence of Chinese Medicine and WHO Three-step Program on Dose,Interval and Side Effects of Strong Opioids

作　　者：殷东风[1] 高宏[1] 周立江[1] 潘玉真[1] 邢向荣[1] 崔小天[1] YIN Dongfeng;GAO Hong;ZHOU Lijiang;PAN Yuzhen;XING Xiangrong;CUI Xiaotian(The Department of Oncology of The Affiliated Hospital of Liaoning University of Tradition Chinese Medicine,Shenyang 110032,Liaoning,China)

机构地区：[1]辽宁中医药大学附属医院肿瘤科

出　　处：《实用中医内科杂志》2019年第11期1-4,共4页Journal of Practical Traditional Chinese Internal Medicine

基　　金：国家中医药管理局重大疑难疾病中西医临床协作试点“胃癌”项目(201802)

摘　　要：世界卫生组织(WHO)癌症三阶梯止痛方案(简称WHO三阶梯方案)的5个原则(阶梯给药、口服给药、按时给药、个体化、注意细节),已成为中国各级医院治疗恶性肿瘤癌痛的标准方案,强调按时、足量使用镇痛剂。中医药参与恶性肿瘤治疗也成为中国肿瘤治疗的特色,包括中药汤药、中成药(口服或静点)、针灸、中药外敷等,成为癌痛治疗的重要组成部分,并与"WHO三阶梯方案"重叠/交替应用;合并癌痛患者继续用1、2、3阶梯止痛药物,中、西医治疗重叠/交替,能取得叠加止痛效果;中医药与强阿片类药联合、双轨滚动、缓慢升阶癌痛治疗方案,改善癌性疼痛规范化管理实施,中药复方汤药内服、外敷、静脉药物、针灸等并用,侧重应用止痛中药可替代(部分患者) 1阶梯非甾体药,至癌痛发展阶段直接进入二、三阶梯;减少了"WHO三阶梯方案"强阿片类药物(吗啡、羟考酮、芬太尼等)使用剂量,延长给药间隔,提高止痛效果,降低副作用强度,改善癌痛患者真实世界的就医体验;很多患者亦主动要求延长强阿片类药服用时间间隔,要求中医药治疗是患者的刚性需求。此与"WHO三阶梯方案"强调阶梯、按时、足量使用镇痛剂原则相悖,真实世界是过分强调严格遵循"规则"还是以患者感受为主判断值得深思。在强阿片类药轨道缓慢升阶过程中,按时给药的延时效应,既可减少癌痛患者的心理压力,又可提高生活舒适度,重要的是可提供中西医汇通融合、彰显中医药特色的中国本土化治疗癌痛方案。未来期待强化循证医学(临床试验、系统综述与Meta分析等)及基础等方面深入研究。The world health organization(WHO) three-step cancer pain relief program(WHO three-step program) has five principles: step-based administration,oral administration,timely administration,individualization and attention to details. It has become the standard treatment program for cancer pain of malignant tumors in hospitals at all levels in China,emphasizing the timely and sufficient use of analgesics. Traditional Chinese medicineinvolving in malignant tumor treatment has become the characteristic of tumor treatment in China,including Chinese medicine decoction(oral or intravenous dripping),acupuncture,external treatment,etc.,and also has become an important part of the treatment of pain,and combined with the three-step overlapping/alternated application. Patients who have cancer pain continue to use 1,2,3 ladder analgesic drugs and overlapping/alternation between Chinese and western medicine,and can obtain the superposition analgesic effect. With strong opioid drugs and traditional Chinese medicinepain treatment,improved standardized management of cancer pain,Chinese medicine compound internal and external treatment,intravenous drugs,acupuncture and moxibustion,etc,focusing on the application of pain medicine alternative(partial) in patients with 1 ladder non-steroidal drugsand directly into the second and third lad-der when the pain develops,it reduces the dosage of strong opioids morphine,oxycodone,fentanyl,etc.) in the " WHO three-step plan",prolongs the drug delivery interval,improves the analgesic effect,reduces the intensity of side effectsand improves the medical experience of cancer pain patients in the real world.Many patients also volunteered to extend the interval between opioids. TCM treatment is the rigid demand of patients. This is contrary to the " WHO three-step plan",which emphasizes the principle of ladder,time and sufficient use of analgesics. It is worthy of pondering whether the real world overemphasizes strictly following the " rules" or mainly focuses on patients' feelings. In the process of

关 键 词：恶性肿瘤 癌痛 WHO三阶梯方案 强阿片类 吗啡 羟考酮 芬太尼 用药剂量 用药间隔 副作用 中药复方 刚性需求 真实世界 

分 类 号：R730.5[医药卫生—肿瘤]