CAJ | 학술논문

目的老年癌症疼痛病人未得到足够止痛治疗的情况较常见.探讨老年癌症疼痛病人接受芬太尼透皮贴剂治疗的止痛疗效及安全性.方法全国23省市136家医院参加了此项多中心开放性临床试验,共计1664例年龄≥65岁的老年癌痛病人接受芬太尼透皮贴剂治疗的止痛治疗,平均年龄72.6岁(65～90岁).结果治疗前疼痛程度评分均值为7.34.治疗d1、d3、d6、d9、d15、d30疼痛程度评分均值分别降低至3.82,2.80,2.43,2.11,1.83,1.79(P=0.000),总有效率97.18%.芬太尼透皮贴剂的初始、15d和30d用药剂量均值分别为31.34μg/h,40.59μg/h和47.50μg/h(25～200μg/h).连续用药15d,91.8%病人的用药剂量仍然维持在25～50μg/h,7.5%病人用药量75～100μg/h,仅0.8%病人的用量为125～200μg/h.治疗前25.4%病人生活质量良好,治疗后15d和30d,71.15%和73.04%病人生活质量良好(P=0.0000).不良反应:便秘10.70%,恶心11.96%,头晕6.85%,呕吐3.85%,嗜睡2.40%,呼吸抑制0.12%.86.2%病人选择继续用芬太尼透皮贴剂.结论芬太尼透皮贴剂治疗老年癌痛病人安全有效,病人满意度高.推荐老年病人的初始剂量为25μg/h.
목적노년암증동통병인미득도족구지통치료적정황교상견.탐토노년암증동통병인접수분태니투피첩제치료적지통료효급안전성.방법전국23성시136가의원삼가료차항다중심개방성림상시험,공계1664례년령≥65세적노년암통병인접수분태니투피첩제치료적지통치료,평균년령72.6세(65～90세).결과치료전동통정도평분균치위7.34.치료d1、d3、d6、d9、d15、d30동통정도평분균치분별강저지3.82,2.80,2.43,2.11,1.83,1.79(P=0.000),총유효솔97.18%.분태니투피첩제적초시、15d화30d용약제량균치분별위31.34μg/h,40.59μg/h화47.50μg/h(25～200μg/h).련속용약15d,91.8%병인적용약제량잉연유지재25～50μg/h,7.5%병인용약량75～100μg/h,부0.8%병인적용량위125～200μg/h.치료전25.4%병인생활질량량호,치료후15d화30d,71.15%화73.04%병인생활질량량호(P=0.0000).불량반응:편비10.70%,악심11.96%,두훈6.85%,구토3.85%,기수2.40%,호흡억제0.12%.86.2%병인선택계속용분태니투피첩제.결론분태니투피첩제치료노년암통병인안전유효,병인만의도고.추천노년병인적초시제량위25μg/h.
Objective: To assess the effect and adverse effects of transdermal fentanyl for elderly patients with cancer pain in China. Methods: A total of 1664 elderly patients (aged 65-90 with mean age of 72.6)with cancer pain enrolled in the multicenter study from 136 institutes in China. Of them, 408 (28.8%)patients were 75 years old or older. All patients received transdermal fentanyl for the management of cancer pain. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment. Results: Baseline mean of pain intensity was 7.34. On day 1, 3, 6, 9 15, and 30, the pain mean scores were decreased to 3.82, 2.80, 2.43, 2.11, 1.83, 1.64 (P= 0.000). The effective rate was97.18%. The mean doses of fentanyl was 31.34 μg/h (25-150 μg/h) initially, and 40.59 μg/h and 47.50μg/h (25-200 μg/h) at day 15 and day 30. At treatment day 15, the dose of fentanyl was ranged from25 to 50 μg/h in 91.8% of patients, 75 to 100 μg/h in 7.5% patients, and 125 to 200 μg/h only in 0.8% patients. The fine quality of life was in 25.4% patients before treatment, and was 71.15% and 73.04%at day 15 and day 30 respectively (P=0.0000). The common side effects were constipation (10.70%),nausea (11.96%), dizzy (6.85%), vomiting (3.85%), sedation (2.40%), respiratory depression (0.12%). 86.2% patients preferred continue treated by transdermal fentanyl. Conclusion: Transdermal fentanyl for the elderly with cancer pain is effective, safe, convenient, and can improve the quality of life. Transdermal fentanyl can be recommended as a first-line drug for the treatment of elderly patients with moderate to severe cancer pain, and the initial doses is recommended as 25μg/h.