摘要
目的观察芬太尼透皮贴剂对肝肾功能受损伴腹腔积液的晚期癌症患者中重度疼痛的镇痛效果、安全性、不良反应及生活质量的改善情况。方法将晚期癌症伴肝肾功能受损的慢性持续性中重度疼痛患者98例按随机数字表法分为两组，56例使用芬太尼透皮贴剂的患者（简称芬太尼组）为试验组，以42例使用硫酸吗啡控释片（商品名：美施康定）的患者（简称吗啡组）为对照组，记录治疗前后疼痛强度、肝肾功能变化指标、不良反应、生活质量等变化情况。结果两组患者治疗前后止痛效果满意，差异无统计学意义（χ2值分别为0．01、0．07、0．01、0．04，均P〉0．05）；两组不良反应便秘、排尿困难差异有统计学意义（χ2值分别为7．32、3．96，均P〈0．05），嗜睡、头晕、恶心、呕吐等差异无统计学意义（χ2值分别为0．12、0．54、0．54、0．02，均P〉0．05），经对症治疗处理大部分不良反应均可缓解或消失；芬太尼组治疗前后肌酐（Scr）、肌酐清除率（Ccr）、丙氨酸氨基转移酶（ALT）、天冬氨酸转移酶（AST）差异无统计学意义（t值分别为1．43、1．67、0．91、0．11，均P〉0．05），而吗啡组差异有统计学意义（t值分别为17．59、49．17、42．12、36．23，均P〈0．05）；两组患者食欲、精神、睡眠、疲乏、日常生活、面部表情指标较治疗前有改善（吗啡组t值分别为3．37、4．40、2．07、5．66、4．48，均P〈0．05；芬太尼组t值分别为2．03、2．27、3．59、4．16、2．79，均P〈0．05），芬太尼组精神状况改善较明显（t=2．93，P〈0．05）。结论芬太尼透皮贴剂与硫酸吗啡控释片对肝肾功能受损伴癌性腹腔积液中重度癌痛患者的止痛效果相近，止痛效果较好，芬太尼透皮贴剂不良反应较硫酸吗啡控释片轻；对肝肾功能影响小，能明显改善患者的生活质量。
Objective To investigate the clinical efficiency, safety, adverse reactions and health- related life quality of transdermal fentanyl patches for pain management in terminal cancer patients with hepatic and renal dysfunction and ascites. Methods 98 terminal cancer patients with moderate to serve pain combined with abnormal hepatic and renal dysfunction were randomly divided into two groups. Group I （n=56） received transdermal fentany patches. Group II, the control group （n=42）, received morphine controlledrelease tablets. Terms of pain intensity, function of renal and liver, adverse reactions and heath-related quality of life were assessed before and after treatment. Results Patients were satisfied with their pain management in both groups, and no significant difference in pain release was observed between the groups （χ2 = 0.01, 0.07, 0.01, 0.04, P 〉 0.05）. The incidences of constipation and dysuresia were significantly less in the group I compared with that of the group II （χ2 = 7.32, 3.96, P 〈 0.05）. The incidences of hypersomnia, dizzy, nausea and vomiting were similar between the two groups （χ2 = 0.12, 0.54, 0.54, 0.02, P 〉 0.05）. Most of the adverse reactions would relieve or disappear after symptomatic treatment. Values of BUN, CR, ALT, AST were similar before and after treatment in group [ （t = 1.43, 1.67, 0.91, 0.11, P 〉 0.05）. However, in group II, these values were significantly increased after treatment （t = 17.59, 49.17, 42.12, 36.23, P 〈 0.05）. The heathrelated life quality （appetite, spirit, somnus, fatigue, daily life and countenance） were significantly improved after treatment in both groups （the group I t = 3.37, 4.40, 2.07, 5.66, 4.48, P 〈 0.05; the group II t = 2.03, 2.27, 3.59, 4.16, 2.79, P 〈 0.05）, the spirit group I improved more obviously compared with group II （t = 2.93,P 〈 0.05）. Conclusion Transdermal fentanyl patches provides equal pain relief compared with Morphine controlled-release tablets in the terminal cancer patients with
出处
《肿瘤研究与临床》
CAS
2013年第4期245-248,252,共5页
Cancer Research and Clinic
关键词
芬太尼透皮贴剂
肝功能不全
肾功能不全
腹水
Transdermal fentanyl patches
Hepatic insufficiency
Renal insufficiency
Ascites
