癌痛患者阿片类药物镇痛效果不佳的高危因素研究  

High-risk factors for the poor analgesic effect of opioids on cancer pain

作　　者：李静[1] 卫红涛[2] LI Jing;WEI Hongtao(Department of Pharmacy,Beijing Haidian Hospital,Beijing 100080,China;不详)

机构地区：[1]北京市海淀医院药剂科,100080 [2]首都医科大学附属北京友谊医院西药剂科

出　　处：《河北医药》2023年第11期1696-1699,共4页Hebei Medical Journal

摘　　要：目的分析癌性疼痛(简称癌痛)患者阿片类药物镇痛效果不佳的高危因素,为提高癌痛患者镇痛治疗效果提供指导。方法采用前瞻性队列研究方法,选取2021年5月至2022年5月北京市海淀医院收治的164例癌痛患者为研究对象,患者均采用阿片类药物进行镇痛治疗,观察患者治疗7 d时的镇痛效果并分为镇痛效果不佳组(23例)及镇痛效果良好组(141例),统计并比较患者一般资料,采用Logistic回归分析检验癌痛患者阿片类药物镇痛效果不佳的高危因素。结果164例患者经7 d阿片类药物镇痛治疗后,镇痛效果不佳23例,占14.02%(23/164);镇痛效果不佳组与镇痛效果良好组比较,患者未遵医嘱用药、未联合自控镇痛、药物不良反应占比高,贴敷给药占比低,初始NRS评分高,差异有统计学意义(P<0.05);Logistic回归分析显示,初始NRS评分过高、未遵医嘱用药、未联合自控镇痛均为癌痛患者阿片类药物镇痛效果不佳的高危因素(P<0.05)。结论癌痛患者阿片类药物镇痛效果不佳发生率较高,对初始NRS评分高,依从性差的患者,在选用阿片类药物阵痛时,临床需针对上述因素采取合理的干预措施提高镇痛效果,减轻患者痛苦。Objective To analyze the high-risk factors for the poor analgesic effect of opioids on cancer pain,thus providing guidance for improving the analgesic effect of cancer pain.Methods It was a prospective cohort study involving 164 cancer pain patients admitted to Beijing Haidian Hospital from May 2021 to May 2022.All patients were treated with opioids for analgesia and the analgesic effect was observed after 7 days of treatment.They were divided into poor analgesic effect group(23 cases)and good analgesic effect group(141 cases).Baseline characteristics of patients were analyzed and compared.Logistic regression analysis was applied to identify the high-risk factors for poor analgesic effect of opioids on cancer pain patients.Results After 7 days of opioid analgesic treatment,23/164(14.02%)patients with cancer pain had a poor analgesic effect.Compared with those of good analgesic effect group,the proportion of patients who did not follow the prescription,and did not combine with patient-controlled analgesia was significantly higher,and the incidence of adverse events was significantly higher in the poor analgesic effect group,while the proportion of giving to paste medication was significantly lower(P<0.05).Meanwhile,the baseline Numerical Rating Scale(NRS)scores were significantly higher in patients of poor analgesic effect group than those of good analgesic effect group(P<0.05).Logistic regression analysis showed that the high baseline NRS score,failure to follow the prescription,and failure to combine patient-controlled analgesia were all high-risk factors for poor analgesic effect of opioids on patients with cancer pain(P<0.05).Conclusion The incidence of poor analgesic effect of opioids in cancer pain patients is high.For patients with high baseline NRS score and poor compliance,when choosing opioids for labor pain,it is necessary to take reasonable intervention measures to improve the analgesic effect and reduce the cancer pain of patients.

关 键 词：癌性疼痛 阿片类药物 疼痛强度数字分级法评分 自控镇痛 

分 类 号：R441.1[医药卫生—诊断学]