奥施康定联合罗通定治疗老年晚期癌痛患者中重度疼痛的临床研究

摘要

Objective:To investigate the effect safety,and adverse effect of oxycodone hydrochloride controlled-release tablets and rotundine in the treatment of elderly patients with severe cancer pain.Methods:All 160 elderly pa-tients suffering severe cancer pain were randomly divided into three groups,53 cases of group A were given morphine sulfate,53 cases of group B were given oxycodone hydrochloride controlled-release tablets,54 cases of group C were given oxycodone hydrochloride controlled-release tablets and rotundine.Their pain scores,quality of life,the chronic pain self-efficacy scale and adverse effects would be reevaluated simultaneously.Results:The ultimately daily titra-ted dosage of group C was lower than the group B(P<0.05).Compared with group A and B,the overall response re-lief rate was 94.4%.The analgesia by oxycodone hydrochloride controlled-release tablets and rotundine significantly improved the patient's quality of life,with the CPSS increased obviously.There were no serious adverse reactions in three groups,but the constipation of group C was lower than that of group A(P<0.05).Conclusion:In the treatment of various degrees of cancer pain,the analgesic effect of combined with oxycodone hydrochloride controlled-release tablets and rotundine is more effective than morphine sulfate,and can be used as substitute of morphine sulfate.%目的：观察奥施康定（盐酸羟考酮缓释片）联合罗通定用于治疗老年晚期癌痛患者中重度疼痛的治疗效果、疼痛自我效能感、不良反应及生活质量改善情况。方法：将160例老年晚期中重度癌痛患者随机分为A、B、C三组，A组53例采用硫酸吗啡缓释片治疗，B组53例采用盐酸羟考酮缓释片治疗，C组54例采用盐酸羟考酮缓释片联用罗通定治疗，根据患者疼痛控制情况调整患者用药剂量，从而达到有效的镇痛效果，并观察患者生活质量改善情况、不良反应及评定患者的疼痛自我效能感。结果：A组（硫酸吗啡缓释片组）总有效率为92．5％，B组（盐酸羟考酮缓释片组）总有效率为88．7％，C组（盐酸羟考酮缓释片＋罗通定组）总有效率为94．4％，三组总有效率差异无统计学意义（P＞0．05），B组盐酸羟考酮缓释片的最终滴定剂量为（204．03±30．45）mg/天，C组盐酸羟考酮缓释片的最终滴定剂量为（163．67±25．49）mg/天，C组与B组相比差异有统计学意义（P＜0．05）；三组患者治疗后生活质量均较治疗前明显改善（P＜0．05），与B组相比，C组的生活质量改善显著（P＜0．05），但B组和A组相比，差异无统计学意义（P＞0．05）；疼痛自我效能感较治疗前明显提高（P＜0．05），与B组相比，C组的疼痛自我效能感更高（P＜0．05）；三组患者治疗过程中的不良反应以嗜睡和便秘常见，其次是恶心、呕吐，无呼吸抑制及成瘾性的发生。结论：罗通定可增强盐酸羟考酮的镇痛、镇静作用，降低其抑制癌痛的用药剂量，两者联用在治疗老年晚期癌痛患者中重度疼痛方面安全有效性高，不良反应小，生活质量明显提高，管理疼痛及疼痛相关症状的能力增强，具有重要的临床推荐价值。