疼痛门诊慢性非癌痛患者阿片类药物使用情况分析及评价*

Analysis and evaluation of opioid use in patients with chronic non-cancer pain in pain clinic *

摘要:

目的：分析疼痛专科门诊慢性非癌痛患者阿片类药物的使用情况,为慢性非癌痛患者合理用药提供参考。方法：回顾性分析2022年3 ~ 8月疼痛科门诊中慢性非癌痛患者使用阿片类药物的处方,整理患者基本信息、疾病病种、药物用量等信息,结合指南进行处方的合理性评价。结果：共收集处方1102张,涉及1070例次患者。使用最多的品种为盐酸曲马多缓释片,为691例次(占比54.41%)。阿片类药物日剂量在50 ~ 90 吗啡毫克当量(morphine milligram equivalents,MME)范围内的患者最多,为604例次(占比56.45%)。老年(年龄≥65岁)患者的阿片类药物平均日剂量为80 MME,显著高于非老年(＜65岁)患者的40 MME(Z=6.03, p＜0.001)；男性患者的平均阿片类药物日剂量(80 MME)与女性患者(80 MME)无统计学差异(Z=0.18, p＞0.05)。依据指南,我院阿片类药物处方共含21种/类慢性非癌痛适应症。1833疾病例次(占比96.37%)含18类/种适应症,在指南中被推荐可选用阿片类药物治疗；18疾病例次(占比0.95%)含2种 /类适应症,在不同指南中对是否可以使用阿片类药物治疗的推荐存在争议。结论：门诊慢性非癌痛患者的阿片类药物使用合理性高,老年患者使用日剂量相对较大,需要给予更多药学监护。

Abstract:

OBJECTIVE: Analyse the application of opioids in outpatients with chronic noncancer pain in department of painology, so as to provide a reference for rational use of medicine clinically. METHODS: Retrospective analysis was performed to extract prescriptions of opioids for chronic noncancer pain in outpatient department of painology from March to August 2022. Data were analyzed including the patients’ basic information, disease, and dosage, and the rationality of prescriptions with opioids was accessed based on guidelines. RESULTS: We had enrolled a total of 1102 prescriptions, including 1070 outpatients. Patients taking Tramadol Hydrochloride Sustained-release Tablet was the most, accounting for 691 cases (54.41%). The number of patients with daily dose of opioids ranging from 50 to 90 MME was the most, accounting for 604 cases (56.45%).The average daily dose of opioids in patients aged ≥ 65 years was 80 MME, significantly higher than that in patients aged < 65 years (40 MME, Z=6.03, p < 0.001). There was no significant difference in average daily opioid dose between male patients (80 MME) and female patients (80 MME) (Z=0.18, p > 0.05). According to the guidelines, a total of 21 indications were prescribed in our hospital.There were 1833 cases (96.37%) of patients, including a total of 18 indications, and the indications were in line with the guidelines to choose opioids for treatment.There were 18 cases (0.95%) of patients, including 2 indications, and the guidelines had different recommendations on whether to use opioids . CONCLUSIONS: The rational use of opioids in outpatient patients with chronic noncancer pain was high，and the daily dose of elderly patients was relatively large, requiring more pharmaceutical monitoring.