阿片类药物耐受癌痛患者的阿片类用药依从性:一项多中心调查  

Opioid adherence in opioid tolerant patients with cancer pain:a multicenter survey

作　　者：郑小卫 丁海樱 徐思露 宋俞 黄萍 方罗 魏青[3] 孙言才 刘玉国[5] 谢瑞祥[6] 翟青 吴楠[3] 童莹慧 戚雅君 孙娇 辛文秀 张轶雯 汪应红 陈娟[6] 杨琳[6] 赵秋玲[6] 张波[4] 史文娜[5] 邵菁菁[4] 李慧[4] 李辉[5] 樊庆 段存贤 杜琼 杨叶子 张小丹[4] 余辉[6] 汪洋奎[4] 时静 黄静[6] 章慧 承华薇[4] 孔思思 陈凌亚 Zheng Xiaowei;Ding Haiyin;Xu Silu;Song Yu;Huang Ping;Fang Luo;Wei Qing;Sun Yancai;Liu Yuguo;Xie Ruixiang;Zhai Qing;Wu Nan;Tong Yinghui;Qi Yajun;Sun Jiao;Xin Wenxiu;Zhang Yiwen;Wang Yinghong;Chen Juan;Yang Lin;Zhao Qiuling;Zhang Bo;Shi Wenna;Shao Jingjing;Li Hui;Li Hui;Fan Qing;Duan Cunxian;Du Qiong;Yang Yezi;Zhang Xiaodan;Yu Hui;Wang Yangkui;Shi Jing;Huang Jing;Zhang Hui;Cheng Huawei;Kong Sisi;Chen Lingya(Center for Clinical Pharmacy,Cancer Center,Department of Pharmacy,Zhejiang Provincial People's Hospital(Affiliated People's Hospital),Hanqgzhou City,Zhejiang Province 310014,China;Deparetment of Pharmacy,Cancer Hospital of University of Chinese Academy of Sciences,Zhejiang Cancer Hospital,Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences,Hangzhou City,Zhejiang Province 310022,China;Deparetment of Pharmacy,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing City,Jiangsu Province 210009,China;Deparetment of Pharmacy,Anhui Provincial Cancer Hospital,The First Affiliated Hospital of University of Science and Technology of China,Hefei City,Anhui Province 230031,China;Deparetment of Pharmacy,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan City,Shandong Province 250117,China;Deparetment of Pharmacy,Fujian Cancer Hospital,Fujian Medical University Cancer Hospital,Fuzhou City,Fujian Province 350014,China;Deparetment of Pharmacy,Fudan University Shanghai Cancer Center,Shanghai City 200032,China)

机构地区：[1]浙江省人民医院药剂科,杭州医学院附属人民医院临床药学中心,肿瘤中心,杭州市310014 [2]中国科学院大学附属肿瘤医院,浙江省肿瘤医院药剂科,中国科学院肿瘤与基础医学研究所,杭州市310012 [3]江苏省肿瘤医院,南京医科大学附属肿瘤医院药剂科,江苏省肿瘤防治研究所,南京市210009 [4]安徽省肿瘤医院,中国科学技术大学附属第一医院西区,安徽省立医院西区药剂科,合肥市230031 [5]山东省肿瘤医院,山东第一医学大学附属肿瘤医院药学部,济南市250117 [6]福建省肿瘤医院,福建医科大学附属肿瘤医院药剂科,福州市350014 [7]复旦大学附属肿瘤医院药剂科,上海市200032

出　　处：《中华疼痛学杂志》2022年第5期629-635,共7页Chinese Journal Of Painology

基　　金：国家自然科学基金(82003189,82173855);浙江省自然科学基金(LQ17H310002,LY20H310001)。

摘　　要：目的调查国内阿片类耐受患者对阿片类药物的依从性现状并分析影响依从性的危险因素。方法使用四条目-用药依从性自评量表,调查2018年1月至2019年10月在国内6家三级甲等肿瘤专科医院接受缓/控释强阿片类药物治疗的302例阿片类耐受癌痛患者的用药依从性,同时使用二元Logistic回归分析影响依从性的因素。结果在收集的302例患者中,患者依从性差者占36.4%(110/302例),癌痛示范化医院的患者依从性显著高于非癌痛示范化医院(69.8%vs.22.9%,P<0.001),门诊和住院患者、不同癌肿间患者治疗依从性差异无统计学意义;患者依从性较差的主要原因为"无正确用药意识"占52.7%(58/110例)。保险类型为城镇居民基本医疗保险的患者依从性较好,新型农村社会养老保险(OR=1.986,95%CI:1.160~3.397,P=0.012)、无任何保险(OR=4.287,95%CI:1.296~14.182,P=0.017)是依从性差的独立风险因素。结论国内阿片类药物用药依从性仍不理想,特别是非癌痛示范化医院,无正确的用药意识是患者层面限制依从性的主要因素,新型农村社会养老保险或没有保险是依从性差的主要风险因素。Objective To observe the adherence of opioids treatment and to analyze risk factors in opioid tolerant patients with cancer pain.Methods Four items-medication adherence self-rating scale was used to investigate the opioids adherence in 302 cancer pain patients received sustained/controlled release strong opioids with opioid tolerant,from January 2018 to October 2019 in 6 Grade III A cancer hospital in China.The risk factors of adherence were analyzed by Binary logistic regression.Results Among 302 patients,36.4%(110/302 cases)were poor compliance.The adherence of opioid was higher in the"Good Pain Management Hospital"(GPM hospital)than that in not granted for GPM hospital(69.8%vs.22.9%,P<0.001).However,there was no significant difference between outpatients and inpatients in opioids compliance.Cancer types was also not associated with the adherence.Patients with basic medical insurance for urban residents had better compliance,while patients with new rural social pension insurance(OR=1.986,95%CI:1.160-3.397,P=0.012)and patients with none insurance(OR=4.287,95%CI:1.296-14.182,P=0.017)were the independent risk factors for poor compliance.Conclusion The adherence of opioids is still unsatisfactory,especially in not granted for GPM hospital.Lack of correct awareness of medication is the main factor for limiting compliance.Patients with new rural social pension insurance and patients have no insurance are associated with poor compliance.

关 键 词：癌症疼痛 阿片类药物 耐受性 依从性 多中心研究 

分 类 号：R969[医药卫生—药理学]