Loick G, Radbruch L, Sabatowski R, Siessegger M, Grond S, Lehmann K A
Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln.
Dtsch Med Wochenschr. 2000 Oct 13;125(41):1216-21. doi: 10.1055/s-2000-7726.
BACKGROUND AND GOAL OF STUDY: Older patients are said to be more sensitive to analgesics and to have a higher risk of side effects due to pharmacokinetic changes developing with old age. On account of this many elderly patients with cancer pain are denied adequate analgesic treatment. We compared efficacy and side effects of cancer pain management in different age groups.
From 1994 to April 1996 577 cancer patients were treated in our pain clinic according to WHO-Guidelines. Efficacy and side effects were evaluated for 508 patients (< 65 years = G1: 323 patients, 65-74 years = G2: 127 patients, > 74 years = G3: 58 patients) with a computerised documentation system.
508 patients were treated on 42,123 days and revisited on 5572 controls. 30 patients were treated longer than 1 year (G1 21 patients, G2 6 patients, G3 3 patients). 143 patients were treated until death. 286 patients were treated on 19,448 days with oral morphine. (G1: 1712 days; G2: 3645 days; G3: 2364 days). Geriatric patients (G3) received significantly higher doses of morphine than younger patients. Adjuvant drugs were given on 81% of treatment days (G1 84%, G2 75%, G3 75%). Incidence and intensity of side effects were not increased in older patients with the exception of urinary disorders.
Geriatric patients with cancer pain can be treated as effectively according to WHO-Guidelines as younger patients. In our study patients in the old age group received significantly higher doses of oral morphine. When analgesic drugs are titrated according to individual needs, side effects are not more frequent or severe than in younger patients.
研究背景与目的：据说老年患者对镇痛药更为敏感，且由于年龄增长导致的药代动力学变化，其副作用风险更高。因此，许多老年癌症疼痛患者得不到充分的镇痛治疗。我们比较了不同年龄组癌症疼痛管理的疗效和副作用。
1994年至1996年4月，我们疼痛门诊按照世界卫生组织指南对577例癌症患者进行了治疗。使用计算机化记录系统对508例患者（<65岁 = G1组：323例患者，65 - 74岁 = G2组：127例患者，>74岁 = G3组：58例患者）的疗效和副作用进行了评估。
508例患者接受了42123天的治疗，并进行了5572次复诊。30例患者治疗时间超过1年（G1组21例患者，G2组6例患者，G3组3例患者）。143例患者接受治疗直至死亡。286例患者接受了19448天的口服吗啡治疗。（G1组：1712天；G2组：3645天；G3组：2364天）。老年患者（G3组）接受的吗啡剂量明显高于年轻患者。辅助药物在81%的治疗日使用（G1组84%，G2组75%，G3组75%）。除泌尿系统疾病外，老年患者副作用的发生率和严重程度并未增加。
老年癌症疼痛患者按照世界卫生组织指南治疗的效果与年轻患者相同。在我们的研究中，老年组患者接受的口服吗啡剂量明显更高。当根据个体需求调整镇痛药剂量时，副作用并不比年轻患者更频繁或更严重。
