培训课件-癌痛如何规范化治疗.pptVIP

盐酸羟考酮缓释片作用时间持续12小时，首剂后12小时仍应重复1次首剂剂量 吗啡是区间：说明个体化差异 * The percentages of patients (Figure 1) that had a Karnofsky score above 40 for at least 50% of the time were 45%, 75%, and 80% in the low, moderate, and high-dose groups, respectively. A similar trend was observed in patients with regards to satisfactory mood (53%, 62% and 72%, respectively), however, these differences were not statistically significant. The percentages of patients with continuous night time sleepmostofthetimewere62%,80%,and72% in the low, moderate and high dose groups, respectively (p = 0.2). * Oxycodone CR is an oral therapeutic option approved for the treatment of moderate to severe pain. It has a similar safety and effi cacy profi le to morphine, but offers several therapeutic advantages. The results of its use at high dosages for pain relief in cancer and non-cancer patients demonstrate that an adequate dose can bring previously uncontrolled moderate to severe pain under control rapidly, with minimal side-effects. However, further randomized, controlled studies involving oxycodone CR and a control arm are required to increase evidence for the effi cacy of oxycodone CR use in cancer and non-cancer pain. 以缓释阿片药物为基础的滴定方法 直接启动口服缓控释阿片类药物 (吗啡或羟考酮) 和即释阿片类药物(prn) 关于这种方法的讨论： 每日使用5–6次吗啡剂量是很麻烦的事情，且降低患者的依从性 患者对过度服药的认知(‘频繁服用好几片药物’) 与依从性降低有关 简化治疗，降低依从性低的风险，提高治疗效果。 Ferrel et al. Assessment and treatment of cancer pain. Seattle: IASP Press, 1998 Fincke et al.J Gen Intern Med 1998 If more than four ‘breakthrough doses’ per day are necessary, the baseline opioid treatment with a slow-release formulation has to be adapted. 2011 ESMO指南提出： 如果每天处理爆发痛超过4次，建议背景用药选择缓释剂型的阿片类药物。 EAPC 阿片类药物治疗癌痛指南 阿片类药物滴定原则 吗啡、羟考酮和氢吗啡酮的口服即释、缓释剂型可用于阿片剂量滴定；用这两种剂型滴定时，均应按需补充口服即释阿片类药物控制爆发痛。 EAPC--Lancet Oncol 2012, 13: e58 奥施康定滴定：奥施康定兼有速释和控释的特点，起效时间和达到最大作用时间与速释吗啡相似，故应在一小时左右评价治疗效果，而药物的缓释部分又可维持8-12小时的稳态血药浓度，相当于给予了稳定的维持剂量。在此基础上用即释吗啡滴定控制爆发痛更简单，实用，迅速。 滴定的方法 盐酸羟考酮缓释片作为滴定起始药物 疼痛评分≥4或疼痛未控制的患者（未达到疼痛控制的目标） 给予15mg口服即释吗啡 (第二轮剂量增加50%-100%) 2-4小时后