盐酸美沙酮片维持治疗重度或难治性癌性疼痛310例的临床观察
염산미사동편유지치료중도혹난치성암성동통310례적림상관찰
Clinic observation of methadone hydrochloride tablets as therapy for 310 patients with severe or refractory cancer pain
  • 万方数据
    临床肿瘤学杂志 림상종류학잡지
    CHINESE CLINICAL ONCOLOGY
    2014年 12期 1107-1112 ,共6页

    黄诚%陈奕贵%张晶%解方为%柯明耀%陈群%吕晓君%陈毅德%陈樟树%王馨%张江灵%詹颖%庞红霞%兰祚均%林小燕%许慎%殷小健

    황성%진혁귀%장정%해방위%가명요%진군%려효군%진의덕%진장수%왕형%장강령%첨영%방홍하%란조균%림소연%허신%은소건

    癌性疼痛%止痛治疗%盐酸美沙酮片%吗啡即释片 癌性疼痛%止痛治療%鹽痠美沙酮片%嗎啡即釋片
    암성동통%지통치료%염산미사동편%마배즉석편
    Cancer pain%Analgesia drug therapy%Methadone Hydrochloride Tablets%Morphine Sustained-release Tablets
    目的：观察盐酸美沙酮片治疗重度或难治性癌性疼痛的镇痛效果和与吗啡片的等效剂量（剂量转换比），以及不良反应。方法对伴有重度或难治性癌痛的晚期癌症患者予吗啡即释片滴定，疼痛强度NRS≤3分后转换为盐酸美沙酮片口服止痛。结果305例重度或难治性癌痛患者接受盐酸美沙酮片2周治疗后有效率为88?85％（其中骨转移痛、肿瘤侵犯或压迫神经的疼痛、难治性疼痛有效率分别为89?89％、86?08％、84?62％）。305例患者第2周末的日平均使用盐酸美沙酮片剂量为（24?56±23?69）mg，其中94?43％患者仅需分2次给药即可。172例成功剂量转换患者稳态的日使用吗啡即释片剂量为（52?08±40?77）mg，转换为盐酸美沙酮片第2周末的日使用剂量平均为（18?36±10?60）mg，转换比约为3∶1。与药物相关的不良反应发生率在1％以下的有尿潴留、疲乏、幻觉、尿频、瘙痒等，发生率1％～3％的有嗜睡、恶心、呕吐、冷汗，头晕发生率为8?06％，便秘发生率为18?06％，未发生与美沙酮相关的严重不良事件，未发现与美沙酮相关的肝、肾功能异常和心电图变化。结论盐酸美沙酮片对于重度或难治性癌性疼痛有效且日使用剂量明显低于吗啡，与吗啡的转换比略高于NCCN指南推荐，不良反应及其发生率与吗啡相似。
    목적：관찰염산미사동편치료중도혹난치성암성동통적진통효과화여마배편적등효제량（제량전환비），이급불량반응。방법대반유중도혹난치성암통적만기암증환자여마배즉석편적정，동통강도NRS≤3분후전환위염산미사동편구복지통。결과305례중도혹난치성암통환자접수염산미사동편2주치료후유효솔위88?85％（기중골전이통、종류침범혹압박신경적동통、난치성동통유효솔분별위89?89％、86?08％、84?62％）。305례환자제2주말적일평균사용염산미사동편제량위（24?56±23?69）mg，기중94?43％환자부수분2차급약즉가。172례성공제량전환환자은태적일사용마배즉석편제량위（52?08±40?77）mg，전환위염산미사동편제2주말적일사용제량평균위（18?36±10?60）mg，전환비약위3∶1。여약물상관적불량반응발생솔재1％이하적유뇨저류、피핍、환각、뇨빈、소양등，발생솔1％～3％적유기수、악심、구토、랭한，두훈발생솔위8?06％，편비발생솔위18?06％，미발생여미사동상관적엄중불량사건，미발현여미사동상관적간、신공능이상화심전도변화。결론염산미사동편대우중도혹난치성암성동통유효차일사용제량명현저우마배，여마배적전환비략고우NCCN지남추천，불량반응급기발생솔여마배상사。
    Objective To evaluate the toxicity and efficacy of methadone hydrochloride tablets as therapy for patients with se?vere or refractory cancer pain, and the equivalent dose of morphine tablets ( dose conversion ratio) , and its safety. Methods Three hundred and ten advanced cancer patients with severe or refractory cancer pain were consecutively enrolled in this study. The patients used morphine sustained?release tablets for the titration, when their pain intensity NRS≤3 then replace methadone hydrochloride tablets for pain treatment. Results Three hundred and five patients with severe or refractory cancer pain who accept methadone hydro?chloride tablets treatment for 2 weeks, pain treatment efficient(response rate,RR) was 88?85%. The RR of bone metastases pain, neuropathy pain and refractory cancer pain were 89?89%, 86?08%, 84?62% respectively. An average day?dose of methadone hydro?chloride tablets was 24?56±23?69 mg, 94?43% of patients within 2 times to take medicine in the 305 patients by the second weekend. One hundred and seventy?two patients with successful dose conversion steady state using morphine sustained?release tablets dose was 52?08±40?77mg per day, into the second weekend methadone hydrochloride tablets using dose averaged 18?36 ±10?60mg per day,conversion rate was about 3:1. The incidence of adverse events associated with drugs under 1% of uroschesis,fatigue, illusion, frequent urination, itching, etc., under 3% of the incidence of drowsiness,nausea, vomiting and cold sweat, dizziness rate was 8?06%,consti?pation rate was 18?06%. There was no case of serious adverse events correlative with Methadone Hydrochloride Tablets, laboratory ex?amination found no effect on liver and kidney function and no electrocardiogram ( ECG ) change. Conclusion Methadone hydrochloride tablets has definite analgesic effect for chronic cancerous pain, dosage is significantly lower than that of morphine. The transformation rate is slightly higher than the NCCN guidelines recommend. The clinical manifestations of the adverse reactions and the incidence are similar to morphin.
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