CAJ | 학술논문

目的：观察和比较持续静脉泵入吗啡与芬太尼透皮贴治疗顽固性癌痛的临床疗效和安全性。方法选择43例NRS≥7分的顽固性癌痛患者，将其随机分为吗啡组（持续静脉泵入吗啡）与芬太尼组（芬太尼透皮贴）。观察和比较两组患者的镇痛疗效、镇痛维持时间、爆发痛发作次数及不良反应发生情况。结果治疗后，吗啡组和芬太尼组的NRS评分分别为（1.9±0.8）分和（2.2±1.0）分，均较治疗前明显降低（P<0.05），但两组间的差异无统计学意义（P>0.05）；吗啡组患者每天平均镇痛维持时间为（22.7±0.4）小时，爆发痛每天发作（1.0±0.3）次；芬太尼组每天平均镇痛维持时间为（20.1±1.2）小时，爆发痛每天发作（1.5±0.6）次，两组间的差异均无统计学意义（P>0.05）。两组患者的不良反应以头晕、便秘、恶心呕吐及排尿困难多见，经对症处理后均可耐受。结论持续静脉泵入吗啡及芬太尼透皮贴治疗顽固性癌痛均可明显缓解患者的疼痛症状，镇痛效果及安全性相当，建议长期住院的患者使用持续静脉泵入吗啡，而不需要长期住院的患者可尝试芬太尼透皮贴治疗。
목적：관찰화비교지속정맥빙입마배여분태니투피첩치료완고성암통적림상료효화안전성。방법선택43례NRS≥7분적완고성암통환자，장기수궤분위마배조（지속정맥빙입마배）여분태니조（분태니투피첩）。관찰화비교량조환자적진통료효、진통유지시간、폭발통발작차수급불량반응발생정황。결과치료후，마배조화분태니조적NRS평분분별위（1.9±0.8）분화（2.2±1.0）분，균교치료전명현강저（P<0.05），단량조간적차이무통계학의의（P>0.05）；마배조환자매천평균진통유지시간위（22.7±0.4）소시，폭발통매천발작（1.0±0.3）차；분태니조매천평균진통유지시간위（20.1±1.2）소시，폭발통매천발작（1.5±0.6）차，량조간적차이균무통계학의의（P>0.05）。량조환자적불량반응이두훈、편비、악심구토급배뇨곤난다견，경대증처리후균가내수。결론지속정맥빙입마배급분태니투피첩치료완고성암통균가명현완해환자적동통증상，진통효과급안전성상당，건의장기주원적환자사용지속정맥빙입마배，이불수요장기주원적환자가상시분태니투피첩치료。
Objective To observe and compare the curative effects and security of continuous intravenous Morphine Pump-ing and fentanyl transdermal patch for patients with intractable cancer pain. Methods Forty-three patients with intractable cancer pain (NRS≥7) were randomly assigned to morphine group (continuous intravenous Morphine Pumping) and fentanyl group (fenta-nyl transdermal patch group). Analgesic efficacy, analgesic time, frequency of intense paroxysmal pain and adverse reactions were observed and compared between the two groups. Results After treatment, the NRS score of morphine group and fentanyl group was (1.9±0.8) and (2.2±1.0) respectively, both were significantly lower than before treatment (P<0.05), but there was no statis-tical difference between the two groups (P >0.05). Patients in morphine group had daily average analgesia maintaining time for (22.7±0.4 ) hours, but (1.0±0.3) times of intense paroxysmal pain attack a day;patients in fentanyl group had daily average analgesia maintaining time for (20.1±1.2) hours, but (1.5±0.6) times of intense paroxysmal pain attack a day. There were no statis-tical differences between the two groups. The most common adverse reactions in the two groups were dizziness, constipation, nausea, vomiting and dysuresia, but all of them could be well tolerated after the symptomatic treatment. Conclusion Continuous intrave-nous Morphine Pumping and fentanyl transdermal patch both could obviously relieve the pain symptoms, and their analgesic effect and security had no differences. It is suggested that long-term hospitalization patients would better receive continuous intravenous pumping morphine, and non-long-term hospitalization patients may try fentanyl transdermal patch therapy.