芬太尼透皮贴剂缓解中重度癌痛76例分析

目的观察临床中重度癌痛患者使用芬太尼透皮贴剂(多瑞吉)的镇痛效果,不良反应及生活质量改善情况。方法采用多中心开放研究,76例中重度临床癌痛患者使用芬太尼透皮贴剂治疗,记录疼痛变化,不良反应及生活质量改善情况。结果76例患者均取得中度以上缓解,其中完全缓解53例(70%),明显缓解15例(20%),中度缓解8例(11%),患者生活质量得到明显改善,毒副作用有嗜睡,头晕,恶心,呕吐,便秘等,无严重毒副作用。结论芬太尼透皮贴剂(多瑞吉)控制癌痛效果较好,能够明显改善患者生活质量,毒副作用轻微,给药方便。     

吗啡皮下注射联合芬太尼透皮贴治疗中重度癌痛患者的并发症及其护理

目的探讨吗啡皮下注射联合芬太尼透皮贴治疗中重度癌痛患者的并发症及其护理。方法选取2010年5月至2011年5月在浙江省肿瘤医院治疗的30例中重度癌痛且口服缓释吗啡耐药患者,采用盐酸吗啡皮下注射,待患者疼痛稳定后将24h所需的盐酸吗啡总量转换成芬太尼透皮贴剂用量,长期维持使用,观察其并发症并给予对症处理。结果本组29例患者疼痛控制良好,1例患者疼痛控制失败。药物不良反应有便秘、恶心、呕吐、头晕、嗜睡、排便困难等,通过精心护理后缓解。结论吗啡皮下注射后芬太尼透皮贴剂长期使用能有效控制疼痛。治疗过程中应加强对早期不良反应的观察及处理,以避免严重并发症的发生。     

芬太尼透皮贴与吗啡治疗癌痛效果的Meta分析

目的：评价芬太尼透皮贴和吗啡缓释片在控制中重度癌痛的效果及不良反应的情况。方法以“芬太尼透皮贴∕多瑞吉∕吗啡∕美菲康∕癌症∕癌痛∕随机∕对照”为关键词,检索公开发表的相关随机对照试验。根据澳大利亚JBI循证卫生保健中心对RCT的评价原则进行文献评价,采用RevMan 5．0软件对本系统评价关注的结局指标进行M eta分析。结果共纳入10篇文献,疼痛缓解率差异无统计学意义,头晕嗜睡、恶心呕吐、便秘发生率差异有统计学意义。结论芬太尼透皮贴剂和口服吗啡控释片治疗中重度癌痛的效果相近,但芬太尼透皮贴剂头晕嗜睡、恶心呕吐、便秘等主要不良反应的发生率较低。     

44例晚期癌痛患者口服吗啡转换为芬太尼贴剂的疗效分析

目的:评价晚期癌痛患者由口服吗啡转换应用芬太尼透皮贴剂止痛的疗效与不良反应。方法:44例口服吗啡镇痛不满意的晚期癌痛患者,换用芬太尼透皮贴剂止痛,吗啡与芬太尼贴剂的剂量换算比为100:1。采用0～10数字疼痛强度评分法评价疼痛强度,评分降低≥2表示疼痛缓解有临床显著性差异;不良反应评估分为4级:无不良反应(0)、轻度(1)、中度(2)或重度(3)。结果:药物转换后疼痛强度明显降低,转换前平均疼痛评分为6.1,转换后7天降至3.5,32例(72.7%)患者疼痛缓解有临床显著性差异。发生至少一种不良反应的患者转换前为34例(77%),转换后降至21例(48%),分别有60%及43%的患者恶心呕吐和便秘症状得到缓解。结论:口服吗啡镇痛不满意的晚期癌痛患者转换应用芬太尼贴剂后镇痛效果提高,胃肠道症状改善。     

盐酸羟考酮控释片和芬太尼透皮贴剂治疗中-重度癌痛的临床疗效及不良反应

目的探究中-重度癌痛患者行芬太尼透皮贴剂和盐酸羟考酮控释片治疗的临床疗效及不良反应。方法选取辽阳石化总医院2015-01—2016-01收治的中-重度癌痛患者96例进行回顾性分析,根据治疗时所用不同治疗方案分成两组,将行盐酸羟考酮控释片治疗42例患者设为对照组,将行芬太尼透皮贴剂治疗54例患者设为观察组,对两组生活质量干扰情况、疼痛状况与不良反应进行对比。结果两组治疗前后精神状况、食欲、生活兴趣与睡眠评分对比差异无统计学意义(P0.05);两组治疗后疼痛缓解率比较差异无统计学意义(P0.05);观察组便秘发生率3.70%比对照组19.05%低,且皮肤过敏发生率12.96%比对照组0高(P0.05)。结论中-重度癌痛患者行芬太尼透皮贴剂和盐酸羟考酮控释片治疗效果相当,临床医师可按照患者具体病情灵活运用,减少不良反应发生。     

芬太尼透皮贴剂缓解老年晚期癌痛及对生活质量的影响

目的:观察芬太尼透皮贴剂治疗老年晚期癌痛的临床疗效、不良反应及使用后生活质量的改善程度。方法:选取30例伴有中、重度疼痛的老年恶性肿瘤患者,使用芬太尼透皮贴剂止痛,至少应用5贴,观察15d,记录治疗前后的疼痛强度、生活质量评分和用药中的不良反应。结果:使用芬太尼透皮贴剂后获得完全缓解20%(6/30),明显缓解30%9/30),中度缓解40/30),轻度缓解3.33%1/30),未缓解(((6.66%2/30),总止痛有效率90%,总获益率93.33%。中度疼痛缓解(率91.67%(11/12),重度疼痛缓解率88.89%(16/18)。不良反应有头晕、嗜睡、便秘、恶心、呕吐、排尿困难、皮肤过敏等,无危及生命的严重不良反应,生活质量明显改善。结论:芬太尼透皮贴剂治疗老年晚期癌痛疗效显著,尤其适用于不能耐受口服止痛药的老年患者。     

芬太尼透皮贴剂对晚期癌痛患者疼痛症状及生活质量的改善作用

目的研究芬太尼透皮贴剂治疗中-重度癌性疼痛的有效性,以及晚期癌痛患者使用芬太尼透皮贴剂对生活质量的影响。方法晚期癌症中-重度患者64例,均因无法口服、不能耐受或口服止痛药无效等改用芬太尼透皮贴剂。采用0～10数字强度分级法记录疼痛强度并采用EORTCQLQ-C30对患者进行生活质量评估,对疼痛缓解结果和生活质量评分进行统计学分析。结果使用芬太尼透皮贴剂12h后,疼痛均有不同程度减轻,完全缓解36例(56%,36/64),明显缓解22例(34%,22/64),中度缓解6例(9%,6/64)。患者的情绪状况、疼痛、恶心和呕吐、食欲丧失、便秘腹泻治疗前后差异有显著性意义(t=2.20～7.71,P<0.01～0.05)。结论芬太尼透皮贴剂用于中-重度癌性疼痛止痛效果好,使用方便,安全、可靠。     

芬太尼透皮贴剂治疗晚期癌痛的效果观察

目的观察芬太尼透皮贴剂治疗癌痛的效果。方法对41例中、重度癌痛患者采用芬太尼贴剂治疗,观察比较治疗前后疼痛缓解率和生活质量评分。结果中度癌痛患者疼痛缓解率100％,重度癌痛缓解率92．8％;癌痛患者生活质量治疗前后比较,差异有统计学意义（p〈0．01）。不良反应主要有头晕、恶心呕吐、便秘、皮肤瘙痒、排尿困难。结论芬太尼透皮贴剂治疗癌痛使用方便,不良反应轻,镇痛作用强、疗效稳定、安全。掌握正确使用的方法,加强心理护理,密切观察药物不良反应、及时采取针对性护理措施,是提高患者用药依从性的关键。     

中重度癌痛患者应用芬太尼透皮贴剂的效果分析

目的探讨中重度癌痛患者应用芬太尼透皮贴剂的效果。方法中重度癌痛患者102例随机分为对照组和观察组,各51例。对照组给予常规护理,观察组在对照组基础上应用芬太尼透皮贴剂。对比2组护理后疼痛改善情况、生活质量评分和不良反应发生情况。结果干预后第6天和第9天时,观察组疼痛缓解显效率和控制率均高于对照组(P0.05);生活质量评价方面,观察组在食欲、睡眠、精神状况、日常生活、疲乏、家庭理解和配合方面评分均显著高于对照组(P0.05或P0.01);观察组恶心、呕吐、便秘、排尿困难发生率显著低于对照组(P0.05)。结论芬太尼透皮贴剂应用于中重度癌痛护理中可明显减轻患者疼痛,提高生活质量,值得借鉴。     

芬太尼贴剂治疗晚期消化道癌痛的临床观察

目的:了解芬太尼贴剂治疗晚期消化道肿瘤中、重度癌痛的镇痛效果和安全性。方法:47例晚期消化道癌痛患者,治疗前均为中、重度疼痛,均因无法口服、不能耐受口服或因肛裂、痔疮不能耐受吗啡类肛注给药者,改用芬太尼透皮贴剂,以数字评分法评定止痛疗效,研究对食欲、睡眠、情绪、一般活动、人际交往、生活乐趣的影响,并观察药物不良反应,至少观察30d。结果:全组47例患者,疼痛完全缓解9例(19.1%),明显缓解21例(44.7%),中度缓解16例(34%),总有效率为97.8%。患者生活质量明显改善,不良反应主要为便秘、恶心、呕吐、皮肤瘙痒及嗜睡等,患者可耐受。结论:芬太尼贴剂治疗中、重度消化道癌痛,镇痛效果好,不良反应发生率低,且使用方便,患者依从性强。     

枢星联合方案预防顺铂(DDP)致恶心呕吐的观察及护理

目的:研究枢星联合方案(枢星联合地塞米松及胃复安)预防顺铂联合化疗所致恶心呕吐的疗效及护理干预。方法:将93例接受以顺铂为主联合化疗的患者随机分为两组,实验组53例接受70周期化疗并给予护理干预;对照组40例接受57周期常规化疗,观察1~5d,对两组恶心、呕吐控制率进行比较。结果:实验组对急性恶心、呕吐控制率分别为90%及94.3%,均较对照组(77.2%和80.87%)明显提高(P<0.05)。结论:枢星联合方案结合护理干预可较好地预防顺铂所致的急性恶心、呕吐,使患者以更为舒适的状态接受化疗。     

头颈部癌症病人术后生活质量研究

目的 :评价头颈部癌症病人术后 1a内的生活质量 (QOL)及其影响因素。方法 :应用欧洲研究和治疗癌症组织核心生活质量调查表 3 0 -项 (EORTCQLQ -C3 0 )和医院焦虑和抑郁等级(HADS) ,评估分析手术或手术加放射治疗的头颈部癌症病人88例术后 1a的QOL。结果 :头颈部癌症病人治疗结束后 1个月与诊断时比较 ,功能维度中的生理活动机能和全身QOL、症状维度中的疲劳、单项中的食欲丧失和便秘所引起的QOL变化有统计学意义 (P <0 .0 1或P <0 .0 5 ) ;治疗结束后 6月与诊断时比较 ,功能维度中的情感活动机能、单项中的失眠所引起的QOL变化有差异 (P <0 .0 1) ;治疗结束后 6个月与 1个月比较 ,症状维度中的疼痛所引起的QOL有差异 (P <0 .0 1) ;治疗结束后 12个月与 6个月比较 ,症状维度中的恶心和呕吐所引起的QOL变化有差异 (P <0 .0 5 )。结论 :治疗后 1个月～ 6个月 ,头颈部癌症病人的生活质量较低 ,护理应提供临床治疗干预和心理干预。     

Long-term therapy of tumor pain using morphine-retard tablets

We analysed the effect of sustained-release morphine tablets in 174 patients with severe cancer pain. A good relief of pain could be obtained in 65% of the patients within the first week and in 80% of the patients at the end of therapy. The mean daily dose was at 178 mg morphine, six patients needed more than 1000 mg per day. The sustained-release morphine was given at fixed intervals, in 80% of the cases every eight hours. No severe side-effects were associated with long-term morphine therapy. We often saw nausea and vomiting, constipation and drowsiness, but these side-effects decreased after the first weeks of treatment. Only in ten patients we had to stop therapy because of side-effects. Morphine can be used successfully in the treatment of cancer pain for long periods without concern about tolerance.     

红外线照射中药溻渍腹部疗法联合中药食疗对胃癌化疗患者胃肠道不良反应的影响

目的 研究红外线照射中药溻渍腹部疗法联合中药食疗对胃癌(gastric carcinoma,GC)化疗患者胃肠道不良反应的影响.方法 选取镇平县中医院2019年8月至2021年1月76例GC化疗患者,根据治疗方案不同分为对照组38例和观察组38例.对照组采用常规西医药物治疗,观察组在对照组基础上加用中医疗法(红外线照射...     

Evaluation of long-term efficacy and safety of transdermal fentanyl in the treatment of chronic noncancer pain.

The objective of this international, multicenter, open-label trial was to assess the efficacy and safety of up to 12 months of therapy with transdermal therapeutic system (TTS) fentanyl in patients (n = 532) with chronic noncancer pain. The trial was completed by 301 (57%) of the patients. The main outcome measures were pain control assessment, global treatment satisfaction, patient preference for TTS fentanyl, and quality of life. The mean dose of transdermal fentanyl (TDF) increased from 48 to 90 microg/h during a period of 12 months. During treatment, on average 67% of patients within the efficacy analysis group (n = 524) reported very good, good, or moderate pain control. Global satisfaction (very good or good) was also stable at 42%. The majority (86%) of patients reported a preference for TDF over their previous treatment (P < .001, binomial test). Short Form 36 quality-of-life scores improved from baseline for bodily pain. The most frequent treatment-related adverse events were nausea (31%), constipation (19%), and somnolence (18%). With regard to opioid-specific adverse events (respiratory depression [< 1%], adrenal insufficiency [< 1%], drug abuse/dependence [1%], and opioid withdrawal syndrome [3%]), these were extremely rare and, with the exception of opioid withdrawal syndrome, none was considered definitively related to the treatment. Long-term treatment with TDF provided a stable degree of pain control in the majority of patients with moderate to severe chronic noncancer pain. It was preferred by the majority of patients compared with their previous opioid medication. Overall, long-term treatment with TDF was generally well tolerated, particularly in view of the low incidence of potentially serious side effects such as drug abuse/dependence and respiratory depression. However, at present, it is important that patients receiving TDF should still be subject to careful assessment and monitoring.     

Validation of the PAC-SYM questionnaire for opioid-induced constipation in patients with chronic low back pain.

Background The Patient Assessment of Constipation Symptoms (PAC‐SYM) questionnaire is a 12‐item self‐report instrument divided into abdominal, rectal and stool domains. Aims This study aimed to (1) evaluate the psychometric properties of PAC‐SYM in assessing the symptoms and severity of opioid‐induced constipation; (2) test for differences in opioid‐induced constipation between Durogesic® fentanyl transdermal reservoir (TDF) and oral sustained‐release morphine (SRM) in patients with chronic low back pain (CLBP). Methods In a 13‐month, open‐label, parallel‐group study, 680 patients were randomised to receive either TDF (n = 338) or SRM (n = 342) for CLBP. Assessments were recorded at Visit 1 (baseline), Visit 5 (Day 29) and Visit 17 (Month 13). Concurrent validity, clinical validity and responsiveness of PAC‐SYM were determined based on patients' confirmation of constipation (CC) scores. Differences in PAC‐SYM scores between treatment groups were also evaluated. Results The study included 677 patients, of whom 638 were opioid‐naïve. Mean PAC‐SYM scores for constipated patients were substantially higher than for non‐constipated patients, demonstrating good clinical validity for PAC‐SYM. The PAC‐SYM could detect changes in bowel function over the treatment period, indicating responsiveness. Homogeneity of each symptom domain exceeded Cronbach's α coefficient of 0.70, suggesting good internal consistency and reliability. Changes in mean PAC‐SYM scores from baseline to Visit 5 and Visit 17 were significantly lower for the TDF group than for the SRM group, indicating that the TDF group experienced less severe constipation. Conclusion PAC‐SYM is a reliable, valid and responsive measure of the presence and severity of opioid‐induced constipation symptoms.     

小柴胡汤合蒿芩清胆汤治疗化疗所致恶心呕吐的临床疗效

目的探讨对化疗后恶心呕吐患者采用小柴胡汤合蒿芩清胆汤治疗的临床疗效。方法选择80例化疗后恶心呕吐患者进行观察,采用随机数字表法将患者分为研究组和对照组,各40例。对照组运用阿瑞匹坦治疗,研究组采用蒿芩清胆汤、小柴胡汤联合治疗。治疗1周,观察2组治疗效果。随访2周,观察2组恶心呕吐症状改善情况及食欲恢复情况。结果研究组治疗总有效率、食欲恢复正常患者比例显著优于对照组,比较差异有统计学意义(P0.05)。结论化疗后恶心呕吐患者采用蒿芩清胆汤、小柴胡汤联合治疗的疗效安全可靠,患者的耐受性好。在改善患者恶心呕吐症状的同时保护胃肠道功能,增强食欲,提高患者的营养状况。     

The efficacy of acupressure to prevent nausea and vomiting in post-operative patients

BACKGROUND: Post-operative nausea and vomiting is a common complication following general anaesthesia. Traditional Chinese medicine indicates that acupressure therapy may reduce nausea and vomiting in certain ailments. AIM(S) OF THE STUDY: The aim of this study was to examine the effect of stimulating two acupressure points on prevention of post-operative nausea and vomiting. DESIGN AND METHODS: A randomized block experimental design was used. The Rhodes Index of Nausea, Vomiting and Retching (INVR) questionnaire was used as a tool to measure incidence. To control the motion sickness variable, the subjects who underwent functional endoscopic sinus surgery (FESS) under general anaesthesia were randomly assigned to a finger-pressing group, a wrist-band group, and a control group. There were 150 subjects in total with each group consisting of 50 subjects. The acupoints and treatment times were similar in the finger-pressing group and wrist-band pressing group, whereas only conversation was employed in the control group. RESULTS: Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure, wrist-band, and control groups, with a reduction in the incidence rate of nausea from 73.0% to 43.2% and vomiting incidence rate from 90.5% to 42.9% in the former. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the former group. CONCLUSION: In view of the total absence of side-effects in acupressure, its application is worthy of use. This study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting.     

Tropisetron versus metoclopramide for the treatment of nausea and vomiting in the emergency department: A randomized,double‐blinded,clinical trial

Aim: We aimed to compare the relative efficacy of tropisetron and metoclopramide in treating nausea/vomiting in undifferentiated ED patients. Methods: We undertook a randomized, double‐blinded, clinical trial. Adult patients requiring treatment for nausea/vomiting were randomly assigned to either tropisetron (5 mg) or metoclopramide (10 mg), by i.v. bolus. The primary end‐point was incidence of vomiting. Secondary end‐points were decrease in nausea score from baseline (0–100 VAS), the requirement of ‘rescue’ anti‐emetics, ongoing nausea over 48 h and side‐effects. Results: Fifty patients were enrolled in each group. The demographic variables, presenting complaints and nausea scores at baseline did not differ (P > 0.05). By 180 min, two (4.0%) and nine (18.0%) patients had vomited in the tropisetron and metoclopramide groups respectively (difference 14.0%, 95% CI 0.1–28.0, P= 0.05). Also, there were two and 20 episodes of vomiting respectively. Vomiting rates were 0.02 and 0.16 episodes/person‐hour (difference 0.14 episodes/person‐hour, 95% CI 0.07–0.21, P < 0.001) respectively. By 60 min and thereafter, the decrease in nausea score from baseline was greater (although not significantly so) in the tropisetron group. At 180 min, the decreases were 47.9 mm and 37.0 mm respectively (difference 10.9 mm, 95% CI ?0.7–22.6). Five (10.0%) and 13 (26.0%) patients required a rescue anti‐emetic respectively (difference 16.0%, 95% CI ?0.7–32.7, P= 0.07). Of patients followed up, 13/47 (27.7%) and 20/49 (40.8%) had ongoing nausea respectively (difference 13.2%, 95% CI ?7.7–34.0, P= 0.25). The tropisetron group had less akathisia. Conclusions: Tropisetron was associated with a significantly lower vomiting rate and shows promise as an alternative anti‐emetic in the ED.     

国产新药盐酸格拉司琼注射液与恩丹西酮预防化疗引起的恶心和呕吐的疗效比较

目的：验证四川抗菌素工业研究所和德阳华康药业有限公司共同研制的盐酸格拉司琼注射液(简称华康格拉司琼)预防恶性肿瘤患者化疗所致恶心与呕吐的有效性和安全性。方法：对69例接受以顺铂为主化疗和39例接受以蒽环类抗肿瘤药为主化疗的恶性肿瘤患者,采用前瞻性多中心随机对照试验,比较该药和国产上市恩丹西酮预防化疗所致恶心与呕吐的疗效和不良反应。结果：华康格拉司琼和恩丹西酮对预防强效致吐和中度致吐化疗药物所致的急性和迟发性恶心和呕吐的疗效基本相同;不良反应亦基本相似,以便秘、疲倦及头痛为多见,但程度轻,不影响继续治疗。结论：华康盐酸格拉司琼注射液预防肿瘤患者化疗所致的恶心与呕吐是安全和有效的。