陈涛　杜建龙　黄修鸿

[摘要] 目的 观察芬太尼联合吗啡用于晚期癌痛患者的临床疗效。 方法 选择我院2014年6月～2016年6月期间收治的晚期癌痛患者100例，两组均行术后硬膜外镇痛（PCEA），采用随机数字表法分为Ⅰ组（芬太尼联合吗啡镇痛）和Ⅱ组（吗啡镇痛），每组50例，比较Ⅰ组与Ⅱ组治疗前及治疗48 h、72 h、96 h后VAS评分、SF-MPQ评分的变化情况以及Ⅰ组与Ⅱ组的疼痛缓解率、不良反应。 结果 两组治疗前VAS评分、SF-MPQ评分比较无统计学差异（P>0.05）；两组治疗48 h、72 h、96 h后的VAS评分、SF-MPQ评分比较分别较治疗前显著降低，且随着时间增加VAS评分、SF-MPQ评分呈明显降低趋势，差异有统计学意义（P<0.05）；且Ⅰ组治疗48 h、72 h、96 h后VAS评分、SF-MPQ评分分别显著低于Ⅱ組，组间比较差异有统计学意义（P<0.05）。两组患者的疼痛完全缓解率、明显缓解率、轻度缓解率比较均无统计学差异（P>0.05）；Ⅰ组的疼痛总缓解率90.0%，显著高于Ⅱ组，组间比较差异有统计学意义（P<0.05）。Ⅰ组的不良反应发生率为10.0%，显著低于Ⅱ组的不良反应发生率38.0%，组间比较差异有统计学意义（P<0.05）。 结论 芬太尼联合吗啡用于晚期癌痛可以显著降低患者的疼痛程度，且安全性好，值得广泛推广和应用。

[关键词] 晚期癌症；芬太尼；吗啡；SF-MPQ评分；VAS评分

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2017）23-0102-03

[Abstract] Objective To observe the clinical curative effect of fentanyl combined with morphine in the patients with advanced cancer pain. Methods 100 patients with advanced cancer pain were selected in our hospital from June 2014 to June 2016. Epidural analgesia（PCEA） was carried out in both groups after the surgery. The patients were randomly divided into groupⅠ（fentanyl combined with morphine analgesia） and group Ⅱ（morphine analgesia） according to the random number table， with 50 patients in each group. The changes of VAS scores and SF-MPQ scores before the treatment and at 48 h， 72 h and 96 h after the treatment were compared between groupⅠ and group Ⅱ， and the pain relief rate and adverse reactions were compared between groupⅠ and group Ⅱ. Results There was no statistically significant difference in VAS scores and SF-MPQ scores between the two groups before treatment（P>0.05）； the VAS scores and SF-MPQ scores of the two groups at 48 h， 72 h and 96 h after the treatment were significantly lower than those before treatment， and the VAS scores and SF-MPQ scores were in a significant decreasing trend with the increase of time. The differences were statistically significant（P<0.05）； the scores of VAS and SF-MPQ in groupⅠ were significantly lower than those in group Ⅱ at 48 h， 72 h and 96 h after the treatment respectively. There were significant differences between the two groups（P<0.05）. There was no statistically significant difference in the total pain remission rate， significant remission rate and mild remission rate compared between the two groups（P>0.05）. The total pain remission rate in groupⅠ was 90.0%， which was significantly higher than that in group Ⅱ， and the difference compared between two groups was statistically significant（P<0.05）. The incidence rate of adverse reactions in groupⅠ was 10.0%， which was significantly lower than that of 38.0% in group Ⅱ. There was statistically significant difference between the two groups（P<0.05）. Conclusion Fentanyl combined with morphine in the treatment of advanced cancer pain can significantly reduce the pain of patients， and the safety is good， which is worthy of extensive promotion and application.

[Key words] Advanced cancer； Fentanyl； Morphine； SF-MPQ scores； VAS scores

疼痛是晚期癌症患者常见的临床症状，严重影响患者的生活质量。晚期癌症患者选择适宜的方法才能最大限度地减轻患者痛苦，提高生活质量。但研究发现，大量晚期中、重度癌痛患者用药过程中对药物产生耐受，从而显著降低疗效，或需加大剂量，但会出现难以耐受的副反应，镇痛效果较差[1]。目前用于晚期癌痛的镇痛药物较多，如芬太尼和吗啡。其中，芬太尼（Fentanyl）别名：枸橼酸芬太尼、多瑞吉，是一种分子结构与吗啡类似的止痛药，研究证实，其镇痛作用比吗啡强约100倍，成瘾性比吗啡小。其适用于各种疼痛及外科、妇科等手术后和手术过程中的镇痛，也用于防止或减轻手术后出现的谵妄，还可与麻醉药合用，作为麻醉辅助用药[2]。吗……