2018 年第 5 期 第 13 卷

盐酸羟考酮缓释片与硫酸吗啡缓释片治疗老年患者中重度癌痛的效果和安全性比较

Efficacy and safety of oxycodone hydrochloride sustained-release tablets and morphine sulfate sustained-release tablets on elderly patients with moderate and severe cancer pain

作者：杨洋吴夏慧罗毅

英文作者：

单位：210028南京中医药大学附属中西医结合医院肿瘤科

英文单位：

关键词：癌痛；盐酸羟考酮缓释片；硫酸吗啡缓释片

英文关键词：

• 摘要：

• 目的    比较盐酸羟考酮缓释片与硫酸吗啡缓释片治疗老年患者中重度癌痛的效果和安全性。方法    回顾性分析2014年1月到2016年12月南京中医药大学附属中西医结合医院收治的124例老年中重度癌痛患者的临床资料，均为首次服用阿片类药物镇痛。按照口服镇痛药种类的不同而分为盐酸羟考酮缓释片组（初始剂量10 mg/次，1次/12 h）和硫酸吗啡缓释片组（初始剂量20 mg/次，1次/12 h），服药期间根据患者疼痛程度调整剂量，连续滴定1周。以患者的疼痛数字评价量表（NRS）评分作为疼痛控制的评价依据，比较2组疼痛控制情况、起效时间、不良反应。结果    盐酸羟考酮缓释片组疼痛控制总有效率略高于硫酸吗啡缓释片组［93.6%（58/62）比90.3%（56/62）］，但差异无统计学意义(P>0.05)。盐酸羟考酮缓释片组中度疼痛、重度疼痛控制总有效率亦略高于硫酸吗啡缓释片组，但差异亦无统计学意义（P>0.05）。盐酸羟考酮缓释片组的平均起效时间明显短于硫酸吗啡缓释片组［(1.3±0.6)d比(1.7±0.9)d］，差异有统计学意义（P<0.05）。盐酸羟考酮缓释片组患者便秘发生率明显低于硫酸吗啡缓释片组［25.8%(16/62)比45.2%（28/62）］，差异有统计学意义（P<0.05），而恶心、呕吐、纳差、嗜睡、瘙痒/皮疹、尿潴留发生率组间差异无统计学意义（P>0.05），不良反应经对症处理后均缓解。结论    与硫酸吗啡缓释片相比，老年中重度癌痛患者应用盐酸羟考酮缓释片镇痛起效快，二者镇痛效果相当，但盐酸羟考酮缓释片相关的便秘发生率较少，安全性好。

• 【Abstract】Objective    To analyze the efficacy and safety of oxycodone hydrochloride sustained-release tablets and morphine sulfate sustained-release tablets on elderly patients with moderate and severe cancer pain. Methods    Clinical records of 124 elderly patients with moderate and severe cancer pain admitted from January 2014 to December 2016 in Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine were retrospectively analyzed. The oxycodone group took oxycodone hydrochloride sustained-release tablets for analgesic therapy with initial dose of 10 mg/12 h; the morphine group took morphine sulfate sustained-release tablets with initial dose of 20 mg/12 h. Analgesic effect was analyzed after 1 week treatment using the Numerical Rating Scale（NRS）; analgesia onset time and adverse drug reactions were observed. Results    Total effective rate of analgesia in oxycodone group was higher than that in morphine group［93.6%（58/62） vs 90.3%（56/62）］(P>0.05). Effective rates of analgesia on moderate pain and severe pain in oxycodone group were higher than those in morphine group(P>0.05). Analgesia onset time in oxycodone group was significantly shorter than that in morphine group［(1.3±0.6)d vs (1.7±0.9)d］（P<0.05）. Incidence rate of constipation in oxycodone group was significantly lower than that in morphine group［25.8%(16/62) vs 45.2%(28/62)］(P<0.05); incidence rates of nausea, vomiting, anorexia, lethargy, itch/rash and urinary retention showed no significant differences between groups(P>0.05). Conclusion    Oxycodone has equal analgesic effect compared to morphine on elderly patients with moderate and severe cancer pain, but it works fast and has less side effects.

  【Key words】Cancer pain;Oxycodone hydrochloride sustained-release tablets;Morphine sulfate sustained-release tablets

  【Fund program】National Natural Science Foundation of China(81773947)