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目的旨在前瞻性地评估晚期癌痛患者对吗啡敏感的个体差异及转换应用另一种阿片类药物止痛治疗的需要、临床获益与不良反应。方法对238例使用口服吗啡的中重度癌痛患者进行评估,是否存在吗啡不耐受。将评估为吗啡不耐受的60例患者随机分为两组:转换应用口服羟考酮(羟考酮组)或芬太尼透皮贴剂(芬太尼组)各30例。阿片转换10d后采用疼痛强度数字评分量表评价临床疗效,并比较羟考酮和芬太尼两组的临床疗效与不良反应。结果发现有74.8%(178/238)的患者使用吗啡止痛有良好的疗效,25.2%(60/238)患者对吗啡不耐受。行阿片转换治疗的患者中,76.7%(46/60)的患者成功控制了疼痛,但羟考酮组与芬太尼组在疗效方面比较无差异(70.0%vs83.3%,P=0.222)。60例患者阿片转换前后发生便秘(63.3%vs18.3%,P=0.000)及恶心呕吐(55.0%vs21.7%,P=0.000)等不良反应的差异有统计学意义,但两组比较无差异。结论对于吗啡不耐受的癌痛患者转换应用口服羟考酮或芬太尼贴剂能显著提高疼痛控制率,改善患者生活质量。
The aim is to prospectively assess individual differences in morphine-susceptible individuals with advanced cancer pain and the need, clinical benefit, and adverse effects of another opioid analgesic. Methods 238 patients with moderate to severe cancer pain using oral morphine were assessed for the presence of morphine intolerance. Sixty patients, assessed as morphine intolerance, were randomized into two groups: 30 for each of oxycodone (oxycodone) or fentanyl (fentanyl). After 10 days of opioid conversion, the clinical efficacy was evaluated by pain intensity digital scale and the clinical efficacy and side effects of oxycodone and fentanyl were compared. As a result, 74.8% (178/238) of the patients were found to have good analgesic efficacy with morphine and 25.2% (60/238) intolerant of morphine. 76.7% (46/60) of the patients undergoing opiate conversion had successful pain control, but there was no difference in efficacy between the oxycodone and fentanyl groups (70.0% vs. 83.3%, P = 0.222) . The difference of adverse reactions such as constipation (63.3% vs 18.3%, P = 0.000) and nausea and vomiting (55.0% vs 21.7%, P = 0.000) before and after opioid conversion in 60 patients was statistically significant, but there was no significant difference between the two groups difference. Conclusion Conversion of oral oxycodone or fentanyl patch for patients with morphine intolerant cancer pain can significantly improve the rate of pain control and improve the quality of life of patients.