生堡盎酡堂盘查；!坚堡!旦璺丝鲞筮!塑鱼!也』垒!型!!堂堂!血垃!Q鲤!!!!丝：№：!癌性疼痛病人静脉吗啡日消耗量与芬太尼透皮贴剂的转换关系于春华罗爱伦黄宇光黄一丹【摘要】目的研究癌性疼痛病人静脉吗啡日消耗量与芬太尼透皮贴剂之间的转换比例。方法晚期癌痛病人13例，先采用吗啡病人自控静脉镇痛(PCIA)48h，随后逐渐转换为芬太尼透皮贴剂镇痛。根据病人疼痛评分及吗啡日消耗量调整芬太尼贴剂的剂量，直至转换成功。记录治疗前、后每天疼痛严重程度(VAS评分)：持续痛VAS、爆发痛VAS，缓解爆发痛所需的吗啡用量、PCIA吗啡日消耗量、芬太尼透皮贴剂剂量，生命体征和副作用。结果静脉对应吗啡日消耗量(ms／d)与芬太尼贴剂转换剂量(ttg／h)之间的直线回归方程为：Y=1．3603X+6．5088。治疗期间病人持续痛强度VAS评分与爆发痛强度VAS评分比治疗前明显降低(P5)whowereconsciousandhadnoobviouscardio·respiratoryandhepato-renaldysfunctionwemenroUedinthisstudy．ThepatientsreceivedintravenousPCAwithmorphineforthefirst48hours．ThePCIAmorphinesolutioncontainedmorphine2-6mg。ml～anddropefidol1-2mg‘30ml～．PCIAincludedabolusdoseofmorphine1-3mgwitha5minlockout．Nobackgroundinfusionw瞄given．MorphinePCIAw鹤thencombinedwithtransdermalfentanyl．Theinitialdoseoftransdermalfentanylwas25ptg‘h～inthefirsttwotothinedays．Thedosewasthengraduallyincreasedin25p-g‘h一1incrementsaccordingtoVASscoresandtheamountofIVmorphineneededtoreducethepersistentpainuntiltransdermalfentanylalonecouldprovidesufficientreliefofpersistentpainandIVmorphinewasgivenonlyforbreakthmuIghpain．Painintensity(VASscores)beforeandaftertreatment，dailyconsumptionofmorphine(mg。d叫)andtransdermalfentanyl(pg·h一)，vitalsignsandsideeffectswererecorded．ResultsThe13patientsincluded6malesand7females．Theirmean(±SD)agewas54±15yrsandbodyweight53±8kg．Therewaspositivecorrelationbetweenthetitrateddoseoftransdermalfentanyl(gg’k“)andtheinitialneedofIVmorphine(mg’day“)．Y=1．3606X+6．5088．PersistentpainintensityandbreakthroughpainintensityevaluatedbyVASSCOreSweresignificantlyreducedduringthetreatment(P
VIP
