CAJ | 학술논문

目的：分析骨转移患者骨痛发病特点、内科治疗效果及预后，并对镇痛药物用药合理性进行分析，以提高临床对骨转移疼痛的诊治水平。方法对123例伴有疼痛的恶性肿瘤骨转移患者进行规范三阶梯止痛治疗及抗肿瘤治疗，并对其临床特征进行回顾性分析。结果总疼痛缓解率85.4%，疼痛程度明显减轻（P<0.05）。各麻醉类药物DUI值均接近1，用药趋向合理。Kaplan?Meier生存分析显示，中度疼痛者生存明显优于重度疼痛者（P=0.015）；疼痛明显缓解者生存明显优于未明显缓解者（P=0.021）；无内脏转移者生存优于伴有内脏转移者（P=0.000）。COX多因素分析结果显示，疼痛程度、是否内脏转移是影响预后的独立危险因素。结论规范治疗可使多数骨转移疼痛患者症状改善，并在一定程度上延长生存时间。阿片类药物对中重度疼痛具有理想的止痛效果，不良反应可以耐受。
목적：분석골전이환자골통발병특점、내과치료효과급예후，병대진통약물용약합이성진행분석，이제고림상대골전이동통적진치수평。방법대123례반유동통적악성종류골전이환자진행규범삼계제지통치료급항종류치료，병대기림상특정진행회고성분석。결과총동통완해솔85.4%，동통정도명현감경（P<0.05）。각마취류약물DUI치균접근1，용약추향합리。Kaplan?Meier생존분석현시，중도동통자생존명현우우중도동통자（P=0.015）；동통명현완해자생존명현우우미명현완해자（P=0.021）；무내장전이자생존우우반유내장전이자（P=0.000）。COX다인소분석결과현시，동통정도、시부내장전이시영향예후적독립위험인소。결론규범치료가사다수골전이동통환자증상개선，병재일정정도상연장생존시간。아편류약물대중중도동통구유이상적지통효과，불량반응가이내수。
Objective To analyze the clinical features,therapeutic effect and prognosis in patients with bone pain induced by malignant bone me?tastasis as well as the rationality of analgesic application,so as to improve the level of diagnosis and treatment for metastatic bone pain. Methods Totally 123 patients with pain due to malignant bone metastasis received antitumor therapy and analgesic therapy based on standardized three?step guidelines. Their clinical characteristics were retrospectively analyzed. Results The total pain relief rate was 85.4%and the pain was significantly relieved(P<0.05). The DUI value of each narcotic agent was close to 1 and the application of narcotic agents tended to be rational. The Kaplan?Meier survival analysis showed that patients with moderate pain had longer survival time than those with severe pain(P=0.015). The survival rate of patients with significant pain relief after treatment was higher than those unrelieved(P=0.021). The survival rate of patients without visceral me?tastasis was higher than those with visceral metastasis(P=0.000). The COX multivariate analysis indicated that the pain intensity and visceral me?tastasis were independent risk factors influencing patient prognosis. Conclusion Standard treatment can improve symptoms in most patients with bone metastasis and prolong survival time. Opioids have satisfactory analgesic effect for moderate to severe pain and the adverse reactions can be tol?erated.