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目的:探讨应用大剂量阿片类药物的晚期癌痛患者转换为持续静脉泵入或持续皮下注射吗啡的转换系数。方法:采用回顾性研究方法,将需要大剂量阿片类药物镇痛但疗效欠佳的晚期癌症患者分为3∶1和2.5∶1组,分别经3∶1或2.5∶1的转换系数将阿片药物等效转换为经静脉或皮下持续注射吗啡注射剂,评估吗啡转换后患者的疼痛缓解程度、止痛有效率、转换过程中滴定次数、稳定止痛时每日等效口服吗啡总量、吗啡相关不良反应等指标,评价经不同转换系数转换后吗啡针剂的镇痛效果。结果:转换后两组患者疼痛缓解程度、止痛有效率和稳定止痛时每日等效口服吗啡总量等差异均无统计学意义(P>0.05)。两组患者吗啡调整次数分别是(1.57±0.93)和(1.00±0.00),差异有统计学意义(P<0.05)。两组主要吗啡相关不良反应均为便秘,发生率差异无统计学意义(P>0.05)。结论:需要大剂量阿片但止痛疗效欠佳的晚期癌痛患者转换为吗啡针剂,使用PCA泵经静脉或皮下持续注射可有效止痛。使用2.5∶1的转换系数可以快速完成转换后的滴定过程,安全、有效地达到有效止痛。
OBJECTIVE: To investigate the conversion factor of morphine into continuous intravenous infusion or continuous subcutaneous injection in patients with advanced cancer with high dose of opioid. METHODS: A retrospective study was conducted in which patients with advanced cancer who required high doses of opioid analgesia but poor efficacy were divided into 3: 1 and 2.5: 1 groups and treated with either a 3: 1 or 2.5: 1 conversion factor The drug was equivalently converted to continuous intravenous or subcutaneous morphine injections to assess the patient’s pain relief after morphine conversion, the analgesic effectiveness, the number of titrations during the conversion, the daily equivalent oral morphine steady-state analgesia, morphine-related adverse reactions And other indicators to evaluate the analgesic effect of morphine injection after conversion with different conversion factors. Results: There was no significant difference in the degree of pain relief, effective analgesia and daily equivalent oral morphine between the two groups after conversion (P> 0.05). Morphine adjustment times were (1.57 ± 0.93) and (1.00 ± 0.00) in both groups, with statistical significance (P <0.05). The two major morphine-related adverse reactions were constipation, the incidence was no significant difference (P> 0.05). CONCLUSIONS: Patients with advanced cancer who require large doses of opioid but poor analgesia are converted to morphine injections and continuous intravenous or subcutaneous injection with PCA is effective in relieving pain. Using a conversion factor of 2.5: 1, you can quickly complete the titration process after conversion and safely and effectively achieve effective analgesia.