术中阿片类药物用量对胰腺癌患者术后生存期的影响  

The impact of the dosage of intraoperative opioids on postoperative survival outcomes in patients with pancreatic cancer

作　　者：张雯惠 刘雪娇 赵刘园 林施延 滕蕾 代俊竹 邵洪雪 邹慧超[1] Zhang Wenhui;Liu Xuejiao;Zhao Liuyuan;Lin Shiyan;Teng Lei;Dai Junzhu;Shao Hongxue;Zou Huichao(Department of Pain Medicine,Harbin Medical University Cancer Hospital,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属肿瘤医院疼痛科,哈尔滨150081

出　　处：《中华医学杂志》2022年第39期3121-3126,共6页National Medical Journal of China

基　　金：黑龙江省卫生健康委科研课题资助项目(2019-058)。

摘　　要：目的探讨胰腺肿瘤切除术中阿片类药物用量对患者术后生存期的影响。方法回顾性分析2013年9月至2018年8月于哈尔滨医科大学附属肿瘤医院行胰腺肿瘤切除术的95例胰腺癌患者的临床资料。患者术中阿片类药物用量经换算,统一表示为芬太尼用量,并通过芬太尼用量将患者分为高剂量组(芬太尼用量≥2.21 mg,n=46)和低剂量组(芬太尼用量<2.21 mg,n=49)。比较两组患者无复发生存时间(RFS)和总生存时间(OS)的差异。采用Cox回归分析影响患者RFS和OS的因素。结果低剂量组患者1、3、5年RFS率分别为75.5%、26.5%、15.2%,OS率分别为77.6%、32.5%、24.4%;高剂量组患者1、3、5年RFS率分别为76.1%、23.9%、12.0%,OS率分别为76.1%、37.0%、15.0%;两组患者间RFS率和OS率差异均无统计学意义(均P>0.05)。多因素Cox分析显示,术中芬太尼用量不会影响患者的RFS(HR=1.205,95%CI:0.737~1.970,P=0.456)和OS(HR=1.062,95%CI:0.634~1.778,P=0.818)。结论术中阿片类药物用量对胰腺癌患者术后RFS率和OS率无影响。Objective To investigate the impact of the dosage of intraoperative opioids on postoperative survival of pancreatic cancer patients who underwent pancreatectomy.Methods The clinical data of 95 patients with pancreatic cancer who underwent pancreatectomy at Harbin Medical University Cancer Hospital from September 2013 to August 2018 were retrospectively collected.Dosage of intraoperative opioid medications was converted to fentanyl equivalent dose.Patients were divided into high-dose group(fentanyl consumption≥2.21 mg,n=46)and low-dose group(fentanyl consumption<2.21 mg,n=49)according to the median intra-operative fentanyl equivalents.The relapse-free survival(RFS)and overall survival(OS)between the two groups were compared.Cox proportional hazards regression model was used to analyze the impact of important covariates on RFS and OS.Results RFS of patients in low-dose group at 1,3 and 5 years was 75.5%,26.5%and 15.2%respectively.OS of patients in low-dose group at 1,3 and 5 years was 77.6%,32.5%and 24.4%respectively.RFS of patients in high-dose group at 1,3 and 5 years was 76.1%,23.9%and 12.0%respectively.OS of patients in high-dose group at 1,3 and 5 years was 76.1%,37.0%and 15.0%.There was no significant difference in RFS and OS between the two groups(all P>0.05).Multivariate Cox analysis showed that dosage of intraoperative fentanyl was not associated with RFS(HR=1.205,95%CI:0.737-1.970,P=0.456)or OS(HR=1.062,95%CI:0.634-1.778,P=0.818).Conclusion Dosage of intraoperative opioid has no effect on RFS and OS in pancreatic cancer patients undergoing pancreatectomy.

关 键 词：胰腺肿瘤 无复发生存期 总生存期 镇痛药 阿片类 

分 类 号：R735.9[医药卫生—肿瘤]