晚期胰腺癌患者爆发性癌痛的影响因素分析  

Analysis of influencing factors for breakthrough cancer pain in patients with advanced pancreatic cancer

作　　者：杨青平 俞嘉[2] 戴连枝 毛顺宝 Yang Qingping;Yu Jia;Dai Lianzhi;Mao Shunbao(Department of Outpatient,The 909th Hospital of Joint Logistic Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;Department of Infection,The 909th Hospital of Joint Logistic Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;Department of Medical Support,The 909th Hospital of Logistic Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第九○九医院(厦门大学附属东南医院)门诊部,漳州363000 [2]联勤保障部队第九○九医院(厦门大学附属东南医院)感染科,漳州363000 [3]联勤保障部队第九○九医院(厦门大学附属东南医院)卫勤处,漳州363000

出　　处：《中华胰腺病杂志》2023年第3期193-198,共6页Chinese Journal of Pancreatology

基　　金：漳州市科技计划项目(ZZ2020J37)。

摘　　要：目的探讨晚期胰腺癌患者发生爆发性癌痛的影响因素。方法根据纳人和排除标准,前瞻性选取2019年1月至2020年12月间联勤保障部队第九O九医院确诊并选择门诊随访的晚期胰腺癌患者为研究对象,根据是否发生爆发性癌痛分为观察组(发生爆发性癌痛)和对照组(无爆发性癌痛发生)。记录患者的年龄、性别,是否呕吐、便秘、睡眠中断,每周基础疼痛次数,是否规律服药、重体力劳动,是否血管侵犯、骨转移、腹腔转移、肺转移,是否手术和放化疗。疼痛评分标准采用数字化疼痛评分(NRS)和视觉模拟评分(VAS)。采用单因素和logistic多因素回归分析爆发性癌痛的相关影响因素。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC)、灵敏度、特异度,分析NRS和VAS评分对于爆发性癌痛的预测价值。结果最终纳入173例患者,其中观察组49例,对照组124例。单因素分析结果显示,年龄≥50岁、便秘、睡眠中断、基础疼痛次数≥3次、无规律性服药、重体力劳动、骨转移、肺转移、有放化疗、高NRS评分、高VAS评分是患者发生爆发性癌痛的影响因素(P值均<0.05);多因素分析结果显示,无规律性服药(0R=1.879,95%CI2.473~4.757,P=0.002)、基础疼痛次数≥3次(0R=2.067,95%CI1.364~6.825,P=0.004)、骨转移(0R=2.756,95%CI 1.153~5.846,P<0.001)、NRS评分(OR=3.787,95%CI2.647~5.958,P<0.001)、VAS评分(OR=2.684,95%CI 1.545~7.878,P<0.001)是爆发性癌痛的危险因素;NRS评分预测爆发性癌痛发生的AUC值为0.665(95%CI 0.573~0.757),临界值为2.5分,灵敏度为61.2%、特异度为77.1%;VAS评分预测爆发性癌痛发生的AUC值为0.608(95%CI0.515~0.701),临界值为2.5分,灵敏度为67.9%、特异度为63.7%;NRS联合VAS评分预测爆发性癌痛发生的AUC值为0.692(95%CI0.604~0.780),临界值为4.5分,灵敏度为81.6%、特异度为79.8%。结论晚期胰腺癌患者爆发性癌痛发生率较高,与多种因素相关,NRS联合VAS评分可�Objective To investigate the influencing factors of breakthrough cancer pain(BTcP)in patients with advanced pancreatic cancer.Method Asccording to the inclusion and exclusion criteria,patients with advanced pancreatic cancer who were diagnosed and followed up by outpatient service in the 909th Hospital of the Joint Logistic Support Force from January 2019 to December 2020 were prospectively selected as the study subjects.According to whether breakthrough cancer pain occurred,all patients were divided into observation group(breakthrough cancer pain)and control group(no breakthrough cancer pain).The relevant clinical data of the included patients including age,gender,presence or absence of vomit,constipation,sleep disruption,frequency of basic pain every week,with or without regular medication,heavy physical labor,with or without vascular invasion,bone metastasis,abdominal metastasis and lung metastasis,as well as whether surgery,radiotherapy or chemotherapy were collected and the data of evaluation indicators during fllow-up were recorded.Digital pain score(NRS)and visual analog score(VAS)were used as pain evaluation score.Univariate and logistic regression were used to analyze the related influencing factors of breakthrough cancer pain.Receiver operating characteristic curve(ROC)was drawn,and area under curve(AUC),sensitivity and specificity were calculated to analyze the predictive value for breakthrough cancer pain.Results A total of 173 patients were included in the study,with 49 cases in the observation group and 124 cases in the control group.Univariate analysis showed that aged≥50 years old,constipation,sleep disruption,frequency of basic pain≥3 times,irregular medication,heavy physical labor,bone metastasis,lung metastasis,radiochemotherapy,high NRS score and high VAS score were the influencing factors for breakthrough cancer pain(all P value<0.05).Multivariate analysis showed that irregular medication(OR=1.879,95%CI 2.473-4.757,P=0.002),basal pain≥3 times(0R=2.067,95%CI 1.364-6.825,P=0.004),bone met

关 键 词：胰腺肿瘤 肿瘤转移 爆发性癌痛 

分 类 号：R735.9[医药卫生—肿瘤]