肿瘤患者阿片类药物相关性便秘严重程度现状及影响因素分析

doi:10.16460/j.issn1008-9969.2019.11.009

摘要/Abstract

摘要： 目的了解肿瘤患者阿片类药物相关性便秘严重程度的现状并分析其影响因素。方法采用方便抽样方法,将2017年10月—2018年10月辽宁省某三级甲等医院193例阿片类药物相关性便秘的肿瘤患者纳入研究,采用自行设计的一般资料问卷、卡氏评分、体力评分、心理痛苦温度计、数字疼痛评分表及肿瘤患者阿片类药物相关性便秘评估量表评分进行调查。采用有序Logistics回归分析肿瘤患者阿片类药物相关性便秘严重程度的影响因素。结果肿瘤患者阿片类药物相关性便秘中轻度便秘29例（15.0%）,中度便秘116例（60.1%）,重度便秘48例（24.9%）。有序Logistics回归分析结果显示,阿片类药物口服天数、奥施康定口服剂量（mg/d）、疼痛程度及近1周每天饮水量是影响肿瘤患者阿片类药物相关性便秘严重程度的独立因素。结论阿片类药物口服天数越长、剂量越大、疼痛程度越重及近1周每天饮水越少导致肿瘤患者阿片类药物相关性便秘的程度越重。

关键词: 肿瘤患者, 阿片类药物, 便秘, 影响因素分析

Abstract: Objective To understand current status of the severity of opioid-related constipation (OIC) in cancer patients and analyze the influence factors. Methods A convenient sampling method was used in the study and 193 cases of OIC in a tertiary grade A hospital in Liaoning Province from October 2017 to October 2018 were investigated by using a self-designed general questionnaire, Kasper Score, Physical Scores, Psychological Pain Thermometers, Digital Pain Scores, and Tumor Patient Opioid-related Constipation Assessment Scale. Ordered logistic regression was used to analyze the influence factors of the severity of OIC in cancer patients. Results Twenty-nine patients (15.0%) had mild constipation, 116 (60.1%) moderate one, and 48 (24.9%) severe one. Ordered logistic regression analysis showed that the oral days of opioids, mg/day of OxyContin, pain level and volumn of drinking water in the past week were independent factors affecting the severity of OIC in cancer patients. Conclusion The longer oral days of opioids, the higher oral dose of OxyContin, the more severe the pain and the less drinking water in the last week, the more serious the degree of OIC in tumor patients.

Key words: tumor patient, opioids, constipation, analysis of influence factor

中图分类号:

R473.73

赵炳媛, 刘凤, 姜桂春, 毛孟婷, 肖丽平. 肿瘤患者阿片类药物相关性便秘严重程度现状及影响因素分析[J]. 护理学报, 2019, 26(11): 9-14.

ZHAO Bing-yuan, LIU Feng, JIANG Gui-chun, MAO Meng-ting, XIAO Li-ping. Current Status of Severity of Opioid-related Constipation in Cancer Patients and Its influence Factors[J]. Journal of Nursing, 2019, 26(11): 9-14.

参考文献

[1] 王薇,曹邦伟,宁晓红,等.北京市癌痛控制20年进步与挑战——北京市多中心癌痛状况调查(FENPAI4090)[J].中国疼痛医学杂志, 2014, 20(1):5-12.DOI:10.3969/j.issn.1006-9852.2014.01.003.
[2] 王莉娜,刘杰,李道睿,等.阿片类药物所致便秘的中医治疗现状[J].中国中西医结合外科杂志,2010,16(1):116-119.DOI:10.3969/j.issn.1007-6948.201001.065.
[3] 姜婧,赵泉霖. 糖尿病性便秘中医治疗研究进展[J]. 世界最新医学信息文摘, 2019,19(16):87-91.DOI:10.19613/j.cnki.1671-3141.2019.16.042.
[4] Camilleri M, Drossman D A, Becker G, et al.Emerging Treatments in Neurogastroenterology: A Multidisciplinary Working Group Consensus Statement on Opioid-induced Constipation[J]. Neurogastroenterol Motil, 2014, 26(10):1386-95.DOI:10.1111/nmo.12417
[5] 毛孟婷. 肿瘤患者阿片类药物相关性便秘评估量表的编制[D].大连:大连医科大学,2018.
[6] 周玲. 慢性疼痛患者整体疼痛评估量表的汉化及信效度评价[D].杭州:浙江大学,2014.
[7] 李庆萍. 健康教育护理路径管理在癌痛规范化治疗中的应用[J].中国医学创新,2013,(31):53-55. DOI:10.3969/j.issn.1674-4985.2013.31.023.
[8] 张叶宁,张海伟,宋丽莉,等.心理痛苦温度计在中国癌症患者心理痛苦筛查中的应用[J].中国心理卫生杂志,2010,24(12):897-902.DOI:10.3969/j.issn.1000-6729.2010.12.004.
[9] Graves K D, Arnold S M, Love C L, et al.Distress Screening in a Multidisciplinary Lung Cancer Clinic: Prevalence and Predictors of Clinically Significant Distress[J]. Lung Cancer, 2007, 55(2):215-224.DOI: 10.1016/j. lungcan.2006.10.001.
[10] Bussière M, Hopman W, Day A, et al.Indicators of Functional Status for Primary Malignant Brain Tumour Patients[J]. Neurol Sci, 2005, 32(1):50-56.
[11] Tibaldi C, Ricei S,Russo F, et al.Increased Dose-intensity of Gemeitabine in Advanced Nonsmall Cell Lung Cancer(NSCLC):A Multicenter PhaseⅡStudy in Elderly Patients from the Polmone Toscano Group (POLTO)[J]. Lung Cancer,2005,48(1):121-127.DOI:10.1016/j.lungcan.2009.02.009.
[12] 梁小珍. 耳穴压丸防治癌痛应用长效阿片类药物后胃肠反应的临床观察[J].湖北中医杂志,2013,35(5):8-9.DOI:10.3969/j.issn.1000-0704.2013.05.003.
[13] 王美琴. 舒适护理对骨折术后患者不良情绪、疼痛及护理满意度的影响[J].智慧健康,2017,3(10):67-68. DOI:10.19335/j.cnki.2096-1219.2017.08.32.
[14] 杨建强,张菊英,罗浩杰,等.五指疼痛评估法在老年带状疱疹患者疼痛评估中的应用[J].中国麻风皮肤病杂志,2018,34(7):424-426.
[15] 赵炳媛,姜桂春,毛孟婷,张立元.阿片类药物相关性便秘诊断的研究进展[J].上海护理,2018,18(8):62-64.
[16] 王国年. 癌症疼痛发生机制[J].中国癌症防治杂志,2017,9(1):1-4. DOI:10.3969/j.issn.1674-5671.2017.01.01.
[17] 王悦,付菊芳,白燕妮,等.癌症患者对化疗导致周围神经病变症状体验及应对方式的质性研究[J].护理学报,2016,23(22):9-13.DOI:10.16460/j.issn1008-9969.2016.22.009.
[18] 言克莉,魏宁,王艳.应用FOCUS-PDCA提高癌痛患者阿片类药物按时服用率的实践[J].护理学报,2016,23(17):34-35.DOI:10.16460/j.issn1008-9969.2016.17.034.
[19] 陈霞,刘伟,蔡小霞,等.癌痛全程管理在提高癌痛患者口服止痛药依从性中的应用[J].护理学报, 2017,24(23):15-18. DOI:10.16460/j.issn1008-9969.2017.23.015.
[20] Tafelski S, Bellin F, Denke C, et al.Diagnostic Performance of Self-Assessment for Constipation in Patients with Long-term Opioid Treatment[J]. Medicine, 2015, 94(50): e2227. DOI:10.1097/MD.0000000000002227.
[21] 占煜,贺小婉,徐红,等. 阿片类药物相关便秘的研究及药物治疗进展[J]. 中国新药与临床杂志, 2016,35(10):683-689. DOI:10.14109/j.cnki.xyylc.2016.10.001.
[22] 董凤良,杜方民,董小芳.阿片类药物导致便秘的机制及治疗[J].医学综述,2014,20(2):288-291.DOI:10.3969/j.issn.1006-2084.2014.02.033.
[23] Galligan J, Akbarali H I.Molecular Physiology of Enteric Opioid Receptors[J]. Am J Gastroenterol Suppl, 2014, 2(1):17-21.DOI:10.1038/ajgsup.2014.5.
[24] Kang M, Maguma H T, Smith T H, et al.The Role of β-Arrestin2 in the Mechanism of Morphine Tolerance in the Mouse and Guinea Pig Gastrointestinal Tract[J]. J Pharmacol Exp Ther, 2012, 340(3):567-576. DOI:10.1124/jpet.111.186320.

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