盐酸羟考酮缓释片与盐酸吗啡缓释片分别联合盐酸吗啡针治疗重度癌痛的疗效对比  

Comparison of therapeutic effects between hydroxycodone hydrochloride sustained-release tablets or morphine hydrochloride sustained-release tablets combined with morphine hydrochloride injection in the treatment of severe cancer pain

作　　者：王鹏远 董雪茹 尚娜娜 刘志 WANG Pengyuan;DONG Xueru;SHANG Nana;LIU Zhi(Department of Oncology,Xuchang Central Hospital,Xuchang,Henan 461000,China)

机构地区：[1]许昌市中心医院肿瘤科,河南许昌461000

出　　处：《重庆医学》2023年第10期1505-1509,1514,共6页Chongqing medicine

基　　金：河南省卫生健康委员会2019医学科技攻关计划联合共建项目(LHGJ20191380);河南省许昌市科技计划项目(20170213242)。

摘　　要：目的探讨盐酸羟考酮缓释片与盐酸吗啡缓释片治疗重度癌痛的疗效及不良反应。方法2017年9月至2019年8月募集该院120例重度癌痛患者,采用抽签法将患者随机分为吗啡组和羟考酮组,吗啡组给予盐酸吗啡缓释片治疗,羟考酮组给予盐酸羟考酮缓释片治疗。两组均使用盐酸吗啡针进行疼痛滴定。观察治疗前及治疗第1、2、3、7天患者疼痛数字评价量表(NRS)评分,治疗第3天疼痛缓解情况,治疗第7天生活质量(QOL)改善情况及不良反应发生情况。结果羟考酮组1例患者在入组后2 h因上消化道出血死亡,最终纳入患者119例,其中吗啡组60例,羟考酮组59例。吗啡组NRS评分:治疗前8(7,8)分、治疗第1天3(2,3)分、治疗第2天2(1,3)分、治疗第3天2(1,2)分、治疗第7天2(1,2)分;羟考酮组NRS评分:治疗前8(7,9)分、治疗第1天3(2,3)分、治疗第2天2(1,3)分、治疗第3天2(1,2)分、治疗第7天2(1,2)分;两组间NRS评分比较,差异无统计学意义(P>0.05);重复测量时间组间差异有统计学意义(P<0.001);以治疗前为参照,治疗后4个时间点NRS评分均下降,差异均有统计学意义(P<0.001)。治疗第3天吗啡组疼痛缓解率为93.3%,羟考酮组为94.9%,两组差异无统计学意义(P>0.05)。两组患者治疗前、治疗后QOL的功能子量表各维度评分比较,差异均无统计学差异(P>0.05);与治疗前相比,治疗后两组患者食欲、睡眠、日常生活、精神状态及人际交往评分均明显增加(P<0.001)。羟考酮组与吗啡组总不良反应发生率无明显差异(44.1%vs.55.0%,P>0.05)。结论盐酸吗啡缓释片和盐酸羟考酮缓释片都能安全、有效地控制重度癌痛。Objective To explore the efficacy and adverse events of hydroxycodone hydrochloride sustained-release tablets and morphine hydrochloride sustained-release tablets in the treatment of severe cancer pain.Methods A total of 120 patients with severe cancer pain were recruited from September 2017 to August 2019 and randomly divided into the morphine group and the oxycodone group by lottery.The morphine group was given morphine hydrochloride sustained-release tablets,and the oxycodone group was given hydroxycodone hydrochloride sustained-release tablets.Morphine hydrochloride injection was used for pain titration in both groups.The scores of pain numerical rating scale(NRS)on the 1st,2nd,3rd,and 7th day of treatment,the pain relief on 3rd day of treatment,the improvement of quality of life(QOL)on the 7th day of treatment,and the occurrence of adverse reactions were observed.Results One patient in the oxycodone group died of upper gastrointestinal bleeding in two hours after enrollment,and 119 patients were eventually included,including 60 cases in the morphine group and 59 cases in the oxycodone group.NRS scores in the morphine group were as follows:8(7,8)before treatment,3(2,3)on the 1st day of treatment,2(1,3)on the 2nd day of treatment,2(1,2)on the 3rd day of treatment,and 2(1,2)on the 7th day of treatment;NRS scores in the oxycodone group were as follows:8(7,9)before treatment,3(2,3)on the 1st day of treatment,2(1,3)on the 2nd day of treatment,2(1,2)on the 3rd day of treatment,and 2(1,2)on the 7th day of treatment.There was no significant difference in NRS score between the two groups(P>0.05).Compared with before treatment,the NRS score decreased at four time points of treatment,with statistical significance(P<0.001).On the 3rd day of treatment,the pain relief rate was 93.3%in the morphine group and 94.9%in the oxycodone group,and there was no significant difference between the two groups(P>0.05).Comparison of functional subscale scores of QOL before and after treatment between the two groups,there were no statisti

关 键 词：癌性疼痛 羟考酮 吗啡 镇痛药 阿片类 生活质量 

分 类 号：R730.5[医药卫生—肿瘤]