李改英+李薇+苏延军+胡小军

[摘要] 目的 观察盐酸羟考酮缓释片治疗晚期恶性肿瘤疼痛的镇痛效果及不良反应。 方法 选取2015年5月～2016年4月在首都医科大学良乡教学医院进行治疗的晚期恶性肿瘤中重度疼痛患者91例，根据随机数字表法将其分为研究组（46例）和对照组（45例），研究组采用盐酸羟考酮缓释片治疗，对照组采用硫酸吗啡缓释片治疗，根据两组患者的疼痛情况调整药物剂量，连续治疗14 d。比较两组患者的临床疗效、补体、卡氏功能狀态评分（KPS）及不良反应发生率。 结果 研究组的总有效率为91.30%，对照组为95.55%，差异无统计学意义（χ2=0.668，P > 0.05）；镇痛前后，两组患者组间KPS评分和补体C3、C4水平比较，差异均无统计学意义（均P > 0.05）；镇痛后，两组患者KPS评分均较本组镇痛前明显提高（均P < 0.05）；镇痛后，两组患者补体C3、C4水平也显著高于镇痛前，差异均有统计学意义（均P < 0.05）；研究组不良反应发生率（13.04%）明显低于对照组（31.11%），差异有统计学意义（χ2=4.330，P < 0.05）。 结论 盐酸羟考酮缓释片治疗晚期恶性肿瘤疼痛的镇痛效果与硫酸吗啡相当，但不良反应发生率更低，服用更安全。

[关键词] 盐酸羟考酮缓释片；晚期恶性肿瘤；疼痛；不良反应

[中图分类号] R733 [文献标识码] A [文章编号] 1673-7210（2017）05（b）-0092-04

[Abstract] Objective To observe the analgesic effect and adverse reactions of Oxycodone Hydrochloride Sustained-release Tablets in the treatment of pain of advanced malignant tumor. Methods Ninety-one patients with moderate and severe pain of advanced malignant tumor treated in Liangxiang Teaching Hospital， Capital Medical University from May 2015 to April 2016 were selected and divided into study group （46 cases） and control group （45 cases） according to the random number table method. The study group was taken Oxycodone Hydrochloride Sustained-release Tablets， the control group was taken Morphine Sulfate Sustained-release Tablets， the dose was adjusted according to the pain of patients in the two groups， for 14 consecutive days. The clinical effect， complement， Karnofsky performance status （KPS） scores and incidence of adverse reactions between the two groups were compared. Results The total effective rate of the study group was 91.30%， which of the control group was 95.55%， the difference was not statistically significant （χ2=0.668， P > 0.05）. There were no significant differences in KPS score， C3 and C4 between the two groups before and after analgesia （all P > 0.05）； after analgesia， the KPS scores of the two groups were significantly higher than those before analgesia （P < 0.05）； after analgesia， the levels of C3 and C4 in the two groups were also higher than those before analgesia， the differences were statistically significant （P < 0.05）. The incidence of adverse reactions in the study group （13.04%） was lower than that of the control group （31.11%）， the difference was statistically significant （χ2=4.330， P < 0.05）. Conclusion The analgesic effect of Oxycodone Hydrochloride Sustained-release Tablets in the treatment of pain of advanced malignant tumor is almost the same with Morphine Sulfate， but it has lower incidence of adverse reactions and more security of taking medicine.

[Key words] Oxycodone Hydrochloride Sustained-release Tablets； Advanced malignant tumor； Pain； Adverse reaction

疼痛是恶性肿瘤患者常见的伴发症状，发生率可达60%以上，且临床分期越晚患者疼痛越明显，严重影响患者的生活质量[1-2]。目前临床上主要采用硫酸吗啡缓释片进行恶性肿瘤的镇痛治疗，但相关研究显示硫酸吗啡缓释片等治疗的总体有效率不足26%，患者的疼痛评分并无明显改善。阿片类镇痛药物是缓解和治疗癌痛的主要药物，可改善患者的生活质量[3-4]。盐酸羟考酮缓释片是近年来出现的一种新型的阿片类镇痛药物，它能够刺激具有类阿片作用内源性物质的特异性CNS阿片受体，减轻中枢性神经元细胞对于相关疼痛刺激的敏感性，抑制外周神经电冲动的传入，进而减轻患者的疼痛体验，提高止痛药物的临床治疗效果。目前……