【作者】 刘玉梅；

【导师】 李薇；

【作者基本信息】 吉林大学 ， 临床医学， 2014， 硕士

【摘要】 目的：探讨影响慢性中重度癌痛患者镇痛效果的相关因素，为临床镇痛治疗提供一些参考。方法：收集2012年1月至2013年4月在吉林大学白求恩第一医院肿瘤中心确诊为恶性肿瘤伴有慢性中重度癌痛的353例患者的临床资料。所有患者均经过了规范化镇痛治疗。以疼痛强度NRS评分降至≤3分、爆发痛次数≤3次/日、解救治疗次数≤3次/日作为疼痛控制良好的指标，以镇痛治疗7天疼痛控制情况、疼痛控制良好所需时间、疼痛控制良好所需镇痛药物剂量作为评价镇痛难易的指标。分析可能影响镇痛效果的因素包括患者因素：性别、年龄；疾病因素：肿瘤类型、TNM分期、是否存在骨转移；疼痛本身因素：疼痛强度、部位、原因、机制、有无爆发痛及次数。用Logistic回归分析上述因素与镇痛治疗7天疼痛控制情况的关系，用Cox回归分析上述因素与疼痛控制良好所需时间的关系，秩和检验分析上述因素与疼痛控制良好所需镇痛药物剂量的关系。结果：1．353名慢性中重度癌痛患者接受规范化药物镇痛治疗7天时，疼痛控制良好率为84.4％，镇痛治疗使患者KPS评分明显改善（P＜0.0001）。2．Logistic回归及Cox回归分析结果显示，消化系统肿瘤及重度疼痛是导致镇痛7天疼痛控制不佳、疼痛控制良好所需时间长的独立危险因素（P＜0.05）。而性别、年龄、TNM分期、是否存在骨转移、疼痛部位、原因、机制对镇痛7天疼痛控制良好与否及镇痛时间长短无影响（P＞0.05）。3．241例应用强阿片类药物患者中，年龄＜60岁、重度疼痛、存在神经病理性疼痛及频发爆发痛（每天3次以上）的患者，疼痛控制良好所需镇痛药物剂量大（P＜0.05）。性别、肿瘤类型、TNM分期、是否合并骨转移、疼痛原因、部位不影响镇痛药物剂量（P＞0.05）。结论：1．慢性中重度癌痛患者经过规范化药物镇痛治疗，7天疼痛控制良好率为84.4％，且镇痛治疗明显改善患者的KPS评分。2．可致慢性中重度癌痛患者镇痛效果不佳的因素包括：年龄＜60岁、消化系统肿瘤、重度疼痛、存在神经病理性疼痛及频发爆发痛（每天3次以上）。更多还原

【Abstract】 Objective: The overall aim of the present study was to analyze the influencing factorsof the analgesic effects in patients with moderate or severe chronic cancer pain, andprovide some references to clinical analgesic decision-making.Methods: Data from clinical characteristics of353inpatients with moderate orsevere chronic cancer pain in Department of Oncology, The Norman Bethune1stHospital of Jilin University, in January1st,2012to April30th,2013, was analyzed.All the patients were given of standard analgesic treatment. Pain intensity NRS≤3,breakthrough pain≤3times/day, salvage treatment number≤3times/day were usedas the indicators of good pain control. Pain control after7days’ treatment, the timeneeded for good pain control, analgesic doses needed for good pain control werechoosed as the evaluation indicators of analgesic complexity. Propable influencingfactors of analgesic effects consisted of patients’ factors, including gender and age;disease factors, such as type of tumor, TNM staging, having bone metastases or not;pain factors, such as pain intensity, location, causes, mechanism, breakthrough painand its frequency. Logistic regression was used to analyze the correlations betweenthe above factors and pain control after7days’ treatment, and cox regression wasused to analyze the correlations between the above factors and the time needed forgood pain control, while rank-sum test was used for analysis of the associationsbetween the above factors and analgesic doses needed for good pain control.Results:1．After standard analgesic treatment for7days,84.4%of the patients withmoderate or severe chronic cancer pain had good pain control, and analgesictreatment made patients’ KPS improved significantly（P <0.0001）.2．Logistic regression and cox regression analyses showed that digestive systemcarcinoma and severe pain were independent risk factors leading to7days’ poorer pain control and needing longer time for good pain control(P <0.05). The gender, age,TNM staging, pain location, causes, mechanism and bone metastases had norelationship with7days’ pain control and the time needed for good pain control (P>0.05).3. Of241patients who used strong opioids, patients younger than60years old,or those with severe pain, neuropathic pain, frequent breakthrough pain more than3times a day needed more drugs for good pain control (P <0.05). And gender, type oftumor, TNM staging, pain causes, pain location, bone metastases had nothing to dowith the analgesic doses (P>0.05).Conclusions:1．After standard analgesic treatment,84.4%of the patients with moderate orsevere chronic cancer pain had good pain control in7days, and analgesic treatmentsignificantly improved patients’ KPS.2．The factors that might lead to poor pain control in patients with moderate orsevere chronic cancer pain included younger than60years old, the type of digestivesystem carcinoma, severe pain, neuropathic pain, frequent breakthrough pain morethan3times a day.更多还原