220例晚期癌患者居家多模式镇痛服务可行性分析

摘要

Objective To investigate the feasibility and effectiveness of multiple modes on home pain alleviation service used for advanced cancer patients to in prove clinical therapy services.Methods The study was involved with 220 patients with advanced cancers to provide them with multimodal analgesia services at home,from February 2010 to February 2013.Patients in this study had been taking both opioid treatments.They were randomly devided into two groups with the number as 112 and 10g and were given different doses of morphine or other drugs.During the period of observation,data was collected under the M.D.Anderson symptom Inventory (MDASI) score and classification of score on pain.Results Differences of pain scores in the two groups and the MDASI score were significant and presented as skewed distribution.Scores on pain score were between groups were significantly different (Z=-9.735,P＜0.001).The average rankings of A group and B group were 76.68 and 162.79 respectively.Under the application of 0.4 mg alprazolam,the degree of pain alleviation seemed to be better.The differences on comprehensive scores between different drug groups were statistically significant(Z=-13.334,P＜0.001).The average rankings of groups A and B were respectively 59.87 and 179.08.Under the use of 0.4 mg of alprazolam,the results could be considered to show better improvements in symptomatic patients.Application of 0.4 mg alprazolam on patients with advanced-cancer-induced-pain showed a better symptomatic improvement than using morphine.Conclusion Patients with advanced cancers receiving multimodal analgesia short-term sedation therapies at home,showed both ideal feasibility and good effectiveness.When morphine was combined used with midazolam at home,a better outcome could be seen in pain-releasing on patients with cancer,than single morphine analgesia was used.%目的 观察晚期癌痛患者居家多模式镇痛服务的可行性及有效性,为临床治疗提供依据.方法 将桐乡市第一医院2010年2月至2013年2月收治的220例家居多模式镇痛治疗患者作为研究对象,放组前均经阿片类制剂治疗,患者随机分为A组(112例)和B组(108例),分别给予不同剂量吗啡和其他药物,观察期采用MD.安德森症状评估量表(MDASI)评分及疼痛分值.结果 两组患者治疗前后的疼痛评分差值和MDASI评分差值均呈明显的偏态分布.不同用药组间疼痛评分差值的差异均有统计学意义(Z=-9.735,P＜0.001),A组和B组平均秩次分别为76.68和162.79,应用0.4 mg阿普唑仑的患者其疼痛缓解程度较大;不同用药组间MDASI评分差值的差异均有统计学意义(Z=-13.334,P＜0.001),A组和B组平均秩次分别为59.87和179.08,应用0.4 mg阿普唑仑的患者其疼痛症状改善程度更明显.晚期癌痛患者应用0.4 mg阿普唑仑对疼痛及综合症状改善程度优于吗啡.结论 晚期癌痛居家多模式镇痛患者短期镇静治疗具有较好的可行性及有效性,且吗啡联合镇静药对居家晚期癌患者镇痛效果显著优于单用吗啡.