癌痛规范化治疗-ppt课件.ppt

鉴于硫酸吗啡缓释片的良好疗效和耐受性，卫生部将为列为癌痛患者的【】首选药物； * 4年后国家药品监督管理局规定，对癌痛治疗中的吗啡不受药典中关于极量的限制。【】也就是吗啡无极量。这对于癌痛忍受者以及癌痛治疗者都有着莫大的意义。 * 1、重视NSAID类药物的毒副作用，第一阶梯止痛出现首选对乙酰氨基酚（扑热息痛）的趋势； 2、淡化第二阶梯，用药向第三阶梯靠拢，强阿片类用药范围扩大(早用、用足)； 3、阿片类药物品种增加； 4、在坚持口服为主的前提下，考虑其它无创途径。 硫酸吗啡结构稳定。【】于是将硫酸吗啡与纤维素基质混合，【】包被以蜡质层，形成蜡质颗粒，【】无数蜡质颗粒压制成片，制成硫酸吗啡缓释片（美施康定）。病人只需每12小时服药一次持续镇痛。 * Objective: The aim of the study was to evaluate the efficacy and tolerability of oxycodone controlled-release tablets for the relief of moderate-to-severe cancer pain in Chinese patients. Study details: This was a prospective, open-label, multicentre trial conducted at 10 hospitals in Zhejiang Province, China. Two hundred and sixteen patients with cancer pain with a score ≥ 4 (numerical rating scale) at 10 Chinese hospitals. Treatment with oxycodone controlled-release tablets was started at 5mg 12 hourly for patients scoring 4-6 and at 10mg 12 hourly for patients scoring 7. Doses were then titrated on an individual basis. The total mean oxycodone controlled-release tablet dosage was 445.2 ― 361.6mg (range 130-2320mg), with the daily dosages of the vast majority of cases (89%) being between 10mg and 30mg. Outcome: Pain score decreased significantly. Rapid onset of analgesic action occurred within 1 hour in 198 cases (91.7%) of patients following administration of oxycodone controlled-release tablets. 这是国内2006年1824例奥施康定?治疗中至重度癌痛大型临床试验，试验周期8周 结果显示：奥施康定? 有效缓解各种性质癌痛，特别是对于神经病理性疼痛患者的疼痛缓解率较高，末次疗效有 效率高达93.6%，高于总体人群的有效率（90.2%） * 奥施康定有效成分羟考酮主要作用于μ受体，中枢神经系统是其主要作用部位，其次是平滑肌。 奥施康定的镇痛作用强，其等效止痛作用强度与吗啡相比是吗啡的2倍。 奥施康定的药效作用个体差异较小，年龄及性别对奥施康定的药效作用影响不大。 奥施康定的血药浓度与药效作用之间有较好的相关性。因此，可通过检测血药浓度来预见药物的止痛作用。 本表内列出由其它常用阿片类药物向奥施康定转换的每日剂量转换系数，转换公式为：原阿片药物每日剂量(mg/d)×剂量转换系数＝奥施康定每日剂量(mg/d) * Results: Pain was poorly controlled at baseline, with only 18.1% of patients reporting adequate pain relief (NRS 3.5). All other patients reported uncontrolled pain, with an average NRS of 7.81. At baseline assessment, 47.89% of patients had been in pain for up to 3 months, 32.82%