盐酸吗啡片动态滴定方法在肿瘤晚期患儿中的临床研究<sup>★</sup>

doi:10.3969/j.issn.2095-1264.2024.01.13

首页 > 过刊浏览>2024年第1期 >80-86. DOI:10.3969/j.issn.2095-1264.2024.01.13

盐酸吗啡片动态滴定方法在肿瘤晚期患儿中的临床研究★
DOI:
                        10.3969/j.issn.2095-1264.2024.01.13
                    
作者:
                        
                        
                    
作者单位:1.昆明医科大学附属德宏医院/德宏州人民医院，儿科，云南 芒市，678400;2.昆明医科大学附属德宏医院/德宏州人民医院，宁养院，云南 芒市，678400;3.德宏职业学院，云南 芒市，678400
作者简介:封在李，男，儿科学硕士，副主任医师，研究方向：儿童癌症疼痛治疗。
通讯作者:
中图分类号:R729;R730.6
基金项目:★李嘉诚基金会“人间有情”全国宁养医疗服务计划；云南省科技厅科技计划项目（202201AY070001-220）；德宏州人民医院（昆明医科大学附属德宏医院）科学研究基金项目（2022DY008）；云南省教育厅科学研究基金项目（2019J1316）。

Clinical study of dynamic titration of morphine hydrochloride tablets for children with advanced tumors^★

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Affiliation:

1.Department of Pediatrics,;2.Hospice Center, Dehongzhou People's Hospital/ the Affiliated Hospital of Kunming Medical University, Mangshi, 678400, Yunnan, China;3.Dehong Vocational College, Mangshi, 678400, Yunnan, China

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摘要:

目的探讨盐酸吗啡片动态滴定方法在肿瘤晚期患儿中的可行性及其临床效果。方法选取我院2017年10月至2020年7月收治的年龄为8~14岁的38例肿瘤晚期疼痛患儿，将其随机分为传统治疗组（传统组，n=19）和动态滴定治疗组（动态滴定组，n=19）。（1）进行组内治疗前后疼痛数字等级（NRS）评分、生活质量（QOL）评分、卡氏体能状况（KPS）评分比较；（2）进行组间治疗前、治疗后的NRS评分、QOL评分、KPS评分比较；（3）进行组间治疗后副作用比较。结果动态滴定组负滴定人数（率）较传统组多（高），差异有统计学意义（P<0.05）；两组间正滴定人数（率）比较，差异无统计学意义（P>0.05）。组内治疗前后NRS评分、QOL评分、KPS评分比较，差异有统计学意义（P<0.05），传统组与动态滴定组间治疗前、治疗后NRS评分、QOL评分、KPS评分比较，差异无统计学意义（P>0.05）。治疗后动态滴定组胃肠道副作用发生率较传统组低，差异有统计学意义（P<0.05），两组间其余副作用发生情况的差异无统计学意义（P>0.05）。结论盐酸吗啡片动态滴定方法可行，和传统治疗一样能减轻肿瘤晚期患儿疼痛程度，提高患儿生活质量，增强患儿活动能力。动态滴定方法可根据患儿疼痛程度增加或减少镇痛药物剂量，且剂量减少不会导致后续镇痛治疗药物量异常增加。动态滴定方法可减少患儿镇痛治疗的胃肠道副作用，为镇痛治疗中镇痛药物减量提供了临床参考依据。

Abstract:

Objective To investigate the dynamic titration of morphine hydrochloride tablets in children with advanced tumors.Methods Thirty-eight children aged 8~14 years old with advanced tumor pain treated in our hospital between October 2017 and July 2020 were randomly divided into traditional treatment group (traditional group, n=19) and dynamic titration treatment group (dynamic titration group, n=19). (1) Compare the pain numerical rating scale (NRS), the quality of life (QOL) score, and Karnofsky performance status (KPS) score before and after treatment within the groups; (2) Compare the NRS, QOL, and KPS scores before and after treatment between the two groups; (3) Compare the side reactions after treatment between the two groups.Results The number (rate) of negative titration was higher in the dynamic titration group than in the traditional group, and the difference was statistically significant (P<0.05). There was no statistically significant difference in the positive titration number (rate) between the two groups (P>0.05). The differences in NRS score, QOL score, and KPS score before and after treatment within the group was statistically significant (P<0.05). There were no significant differences in NRS score, QOL score, and KPS score between the traditional group and the dynamic titration group both before and after treatment (P>0.05). After treatment, the incidence rate of gastrointestinal side reactions in the dynamic titration group was lower than that of the traditional group, and the difference was statistically significant (P<0.05), while the incidence rate of other side reactions was not statistically significant between the two groups (P>0.05).Conclusion The dynamic titration method of morphine hydrochloride tablets was feasible, and could reduce the pain of children with advanced tumors, improve their quality of life, and enhance their performance status, as effective as traditional treatment. The dynamic titration method could increase or decrease the dose of analgesic drugs according to the degree of pain in the child, and the reduction of the dose would not cause an abnormal increase in the amount of subsequent analgesic treatment. The dynamic titration method could reduce the gastrointestinal side reactions caused by analgesic treatment. It provided a clinical reference for the reduction of analgesic drugs in analgesic treatment.