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目的 :评价硫酸吗啡控释片通过剂量滴定对癌性疼痛的治疗作用。方法 :本次研究共收治148例中重度癌症疼痛患者 ,硫酸吗啡控释片的初始剂量一般由10～30mg 开始 ,观察1～2天疼痛无缓解即进行个体剂量滴定 ,按30%～50 %剂量逐渐递增 ,直到疼痛缓解。如经放、化疗后疼痛减轻而需要减量时 ,按30%～50 %剂量递减。整个治疗期间随时进行剂量滴定 ,一直观察到用药终止。结果 :平均初始剂量、维持剂量及最大剂量分别是50mg/天、60mg/天及90mg/天。平均用药持续天数为51 5天 ,最长者达525天。平均达维持剂量及最大剂量天数分别为3天及12天。48 8 %的患者不需增加初始剂量 ,51 2%的需要增加 ,其中47 2 %的患者增加剂量的范围在35%～300 %之间 ,仅1例 (0 7 % )增加剂量达1750 %。疼痛缓解率为97 3 % ,对各种类型疼痛均有效 ,其中内脏痛和骨痛缓解率无显著性差异 (P>0 05)。119例患者治疗停止的原因依次为死亡82例 (68 9 % ) ,放、化疗等使疼痛缓解16例 (10 8 % ) ,病情进展14例 (9 4% ) ,不良反应7例 (4 % )。副作用主要是便秘 (43 9 % )和恶心 (16 9 % )。结论 :作者强调剂量个体化 ,对慢性癌性疼痛应作为首选药物
Objective: To evaluate the therapeutic effect of morphine sulfate controlled-release tablets by titration on cancer pain. METHODS: A total of 148 patients with moderate-to-severe cancer pain were treated in this study. The initial dose of morphine sulphate controlled-release tablets was generally 10 to 30 mg. Observed 1 to 2 days of pain without remission, ie individual dose titration, at 30% to 50% The dose gradually increases until the pain resolves. If the pain is reduced after chemotherapy and chemotherapy, the dosage should be reduced by 30% to 50%. Dose titrations were performed at any time throughout the treatment period and the termination of the medication was observed. Results: The average initial dose, maintenance dose, and maximum dose were 50 mg/day, 60 mg/day, and 90 mg/day, respectively. The average duration of drug use was 51 5 days and the longest was 525 days. The average maintenance dose and maximum dose days were 3 days and 12 days, respectively. 48 8 % of patients did not need to increase the initial dose, 51 2% of the need to increase, of which 47 2% of patients increased the dose range of 35% to 30%, only 1 (0 7 %) increased dose of 1750% . The pain remission rate was 97 3% and was effective for all types of pain. There was no significant difference in the remission rate of visceral pain and bone pain (P>0.05). The reasons for the cessation of treatment in 119 patients were followed by 82 deaths (68.9%). Radiotherapy and chemotherapy relieved pain in 16 patients (108.8%), progressed in 14 patients (94%), and adverse reactions in 7 patients (4%. ). The main side effects were constipation (43.9%) and nausea (16.9%). Conclusion : The authors emphasize dose individualization and should be the preferred drug for chronic cancer pain