ObjectiveTo systematically review the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain. MethodsDatabases such as The Cochrane Library (Issue 1, 2014), PubMed, Web of Science, CNKI, VIP, CBM and WanFang Data were searched for randomized controlled trials (RCTs) on the efficacy of transdermal fentanyl versus oral morphine for moderate/severe cancer pain up to January 2014. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1.0 software. ResultsA total of 35 RCTs involved 3 406 patients were included. The results of meta-analysis showed that, there was no significant difference in effectiveness between transdermal fentanyl and oral morphine for moderate/severe cancer pain (OR=1.00, 95%CI 0.80 to 1.27, P=0.99). Compared with oral morphine, transdermal fentanyl was better in lowering the incidences of constipation, nausea and vomiting, lethargy and urinary retention; but transdermal fentanyl increased the incidences of skin rashes and itch (P < 0.05). ConclusionTransdermal fentanyl is as effective as oral morphine in the treatment of moderate/severe cancer pain, and transdermal fentanyl causes less side effects. Due to poor quality of the included studies, the above conclusion should be verified by further conducting more high quality RCTs.
目的:評價中藥配合三階梯止痛與單純三階梯止痛比較治療癌性疼痛的有效性和安全性。方法:采用Cochrane系統評價方法，計算機檢索Cochrane圖書館臨床對照試驗資料庫、MEDLINE、CBM、CNKI、VIP和萬方；同時手檢相關期刊和會議論文集，納入有關中藥配合三階梯止痛治療癌性疼痛的隨機對照試驗，并按Cochrane系統評價員手冊4.2.2版推薦的質量評價標準評價納入研究質量，對同質的研究進行Meta分析。結果:共檢索到符合納入標準的中文文獻12篇（1366例患者）。文獻質量評價結果顯示，所有文獻均為C級。Meta分析結果顯示，中藥配合三階梯止痛治療癌痛在近期鎮痛效果、提高生活質量和減少不良反應發生方面優于單純三階梯止痛藥治療。結論:中藥配合三階梯止痛治療癌性疼痛優于單純三階梯止痛治療。但由于納入試驗研究的方法學質量普遍較低，期待更多設計合理、方法科學的大樣本多中心隨機雙盲對照臨床試驗，提供高質量的證據。
ObjectiveTo explore the role of clinical pharmacists in caring for one patient with breast cancer complicated with multiple metastases. MethodsClinical pharmacists monitored the entire treatment process of a patient with breast cancer complicated with multiple metastases. Blood glucose level was recorded, and the pharmacists evaluated the patient's pain, gave appropriate doses of cancer pain drugs, and responded positively to the hand-foot syndrome (HFS) induced by chemotherapeutic drugs. ResultsWith the participation of the pharmacists, clinicians adjusted the medication. Ideal control of cancer pain and blood glucose was achieved with successful chemotherapy, and HFS fully recovered. ConclusionPharmaceutical care by clinical pharmacists can assist clinicians to ensure the safety and effectiveness of drug use.
摘要:目的: 探討深部痛點阻滯在治療頑固性癌痛患者中的作用。 方法 : 將156例頑固性癌痛患者,隨機分為深部痛點阻滯組及對照組,每組78例。深部痛點阻滯組根據疼痛部位,應用軟組織外科學理論找出相應壓痛點,給予痛點深部阻滯治療;對照組找出壓痛點但僅按三階梯用藥原則給予口服藥物治療。 結果 : 深部痛點阻滯組及對照組兩組患者經治療后疼痛控制均較理想(深部痛點阻滯組VAS13, 對照組VAS17),但是深部痛點阻滯組嗎啡用量明顯少于對照組(嗎啡日平用量深部痛點阻滯組為335mg, 對照組為15287 mg)。便秘的發生率深部痛點阻滯組為5384%,對照組為7692%。 結論 : 深部痛點阻滯能較好的控制頑固性癌痛,同時可明顯減少嗎啡的用量,副作用相對發生要少。Abstract: Objective: To investigate the effect of the deeppressed pain points injection on the refractory cancer pain and provide reference for relieving the cancer pain. Methods : One hundred and fiftysix patients with refractory cancer pain were diagnosed by the soft tissue surgery,finding the pain point by pressing deeply,the patients with deeppressed pain points were divided into deeppressed pain points injection group and control group randomly, The patients in deeppressed pain points injection group were treated with deeppressed pain points injection; the patients in control group were treated with drugs according with the WHO analgesic ladder. Results : The patients in deeppressed pain points injection group got the same pain relief as those in control group (VAS 13 in deeppressed pain points injection group, 17 in control group ),but the daily dose of morphine in deeppressed pain points injection group was less than that incontrol group (morphine 335mg/day in deeppressed pain points injection group,15287mg/day in control group ) significantly. There was 5384% patients with constipation in deeppressed pain points injection group, 7692% in control group. Conclusion : The refractory cancer pain can be controlled effectively by the deeppressed pain point injection and the daily dose of morphine to control the cancer pain is decreased significantly. The side effect in deeppressed pain points injection group was less than that in control group.