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目的观察硫酸吗啡控释剂(美施康定)直肠给药的临床疗效与不良反应。方法选择92例中、重度癌性疼痛的男性患者,随机分为口服组和直肠给药组,初给剂量为10 mg,根据疼痛逐渐增加剂量,记录治疗前、后的疼痛强度、生活质量和用药不良反应。结果美施康定使用后口服组Ⅱ度疼痛缓解率43.5%(20/46例),Ⅲ度缓解率39.1%(18/46例),Ⅳ度缓解率8.7%(4/46例);直肠组Ⅱ度疼痛缓解率34.8%(16/46例),Ⅲ度缓解率28.3%(13/46例),Ⅳ度缓解率6.5% (3/46例)。口服给药与直肠给药疼痛缓解率差异有统计学意义(P<0.01)。不良反应口服组便秘者占60.9%(28/46例),排尿困难者占65.2%(30/46例);直肠组便秘者占10.7%(5/46例),排尿困难者占2.2%(1/46例),不良反应有统计学差异(P<0.01)。结论美施康定直肠给药的镇痛效果虽不及口服给药,但可明显减轻胃肠反应及排尿困难,亦能改善癌痛患者的生活质量,尤其适用于前列腺肥大及不能口服用药的患者。
Objective To observe the clinical efficacy and side effects of morphine sulfate controlled release (Meishi Kangding) rectally. Methods A total of 92 male patients with moderate to severe cancerous pain were randomly divided into oral group and rectal group. The initial dose was 10 mg. The pain intensity and quality of life before and after treatment were recorded according to the dose of pain. Adverse drug reactions. Results After oral administration, the second-degree pain relief rate was 43.5% (20/46), the third-degree response rate was 39.1% (18/46), and the fourth-degree response rate was 8.7% (4/46). In the rectal group The pain relief rate of grade Ⅱ was 34.8% (16/46 cases), the rate of Ⅲ degree remission was 28.3% (13/46 cases), and the grade Ⅳ remission rate was 6.5% (3/46 cases). There was significant difference in the pain relief rate between oral administration and rectal administration (P <0.01). Adverse reactions of oral constipation accounted for 60.9% (28/46 cases), dysuria accounted for 65.2% (30/46 cases); rectal constipation accounted for 10.7% (5/46 cases), dysuria accounted for 2.2% ( 1/46 cases), the adverse reactions were statistically significant (P <0.01). Conclusion Although the analgesic effect of rectal administration of mesylokisin is less than that of oral administration, it can obviously relieve the gastrointestinal reaction and dysuria and improve the quality of life of patients with cancer pain. It is especially suitable for patients with benign prostatic hyperplasia and those who can not be taken orally.