影响晚期癌症伴慢性中重度疼痛患者镇痛效果的因素分析

摘要

目的：探讨影响晚期癌症伴慢性中重度疼痛患者镇痛效果的相关因素，为晚期癌症姑息治疗提供一些参考。方法收集260例晚期恶性肿瘤伴有慢性中重度疼痛患者的相关资料，所有患者均进行规范化镇痛治疗。以疼痛强度数字分级法评分降至≤3分，爆发痛次数≤3次／日，解救治疗次数≤3次／日作为疼痛控制良好的指标，以镇痛3天疼痛控制情况、镇痛时间、镇痛药物剂量作为评价镇痛难易的指标。分析性别、年龄、肿瘤类型、有无骨转移、疼痛强度、疼痛部位、疼痛原因、疼痛机制及有无频发爆发痛（每天3次以上）对镇痛效果的影响。结果260例患者镇痛治疗3天疼痛控制良好率为75�4％（196／260），中位镇痛时间为2天。 Logistic回归及Cox回归分析结果显示，消化系统肿瘤、重度疼痛和频发爆发痛是导致镇痛3天疼痛控制不佳（ P＜0�05）及镇痛时间长（ P＜0�05）的独立危险因素，而性别、年龄、骨转移、疼痛部位、疼痛原因和疼痛机制对镇痛3天疼痛控制情况及镇痛时间长短无显著影响（ P＞0�05）。185例应用强阿片类药物患者中，年龄＜60岁（ P＝0�018）、重度疼痛（ P＜0�001）、存在神经病理性疼痛（ P＝0�002）及频发爆发痛（ P＝0�015）的患者需止痛药物剂量大，而性别、肿瘤类型、骨转移、疼痛部位、疼痛原因对镇痛药物剂量无显著影响（ P＞0�05）。结论年龄＜60岁、消化系统肿瘤、重度疼痛、存在神经病理性疼痛及频发爆发痛为影响镇痛效果的危险因素。%Objective To analyze the factors influencing the analgesic effect of pain in advanced cancer patients with moder⁃ate or severe chronic pain, and provide some references to palliative care for advanced cancer patients. Methods Data were collected from 260 advanced cancer patients with moderate or severe chronic pain. All the patients received standard analgesic treatment. Pain in⁃tensity numerical rating scale( NRS)≤3, breakthrough pain≤3 times/day, salvage treatment number≤3 times/day were used as the indicators of good pain control. Pain control after 3 days�treatment, the analgesic time and analgesic doses needed for stable pain con⁃trol were chosen as the evaluation indicators of analgesic complexity. The influences of following factors on the analgesic effects were an⁃alyzed, including gender, age, type of tumor, having bone metastases or not, pain intensity, pain location, pain causes, pain mecha⁃nism and having frequent breakthrough pain( more than 3 times a day) or not. Results In this study, 75�4% of the 260 patients had good pain control( NRS≤3) in 3 days, and the median analgesic time was two days. Logistic regression and Cox regression analyses showed that digestive system carcinoma, severe pain and frequent breakthrough pain were independent risk factors of poorer pain control in 3 days(P value were 0�032,<0�001,<0�001, respectively), and also needed longer time for stable pain control(P value were 0�042, 0�002, 0�013, respectively) , while gender, age, bone metastases, pain location, pain causes and pain mechanism had no re⁃lationship with 3 days�pain control and the time of analgesia( P>0�05) . Of 185 patients who used strong opioids, patients younger than 60 years old(P=0�018), or those with severe pain(P<0�001), neuropathic pain(P=0�002), frequent breakthrough pain(P=0�015) needed more analgesic drugs, while gender, type of tumor, bone metastases, pain causes and pain location had nothing to do with the analgesic doses( P>0�05) . Conclusion Younger than 60 years old, digestive system carcinoma, severe pain, neuropathic pain and frequent breakthrough pain were risk factors of pain control.