Departments of Pain Treatment and Palliative Care Unit, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Clin J Pain. 2011 Oct;27(8):664-7. doi: 10.1097/AJP.0b013e3182168fed.
To identify predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain.
The participants were 76 hospitalized terminal cancer patients who underwent opioid switching from oxycodone or morphine sustained-release tablet to transdermal fentanyl at our hospital between January 2009 and June 2010. The conversion dose was calculated as transdermal fentanyl (25 μg/h)/oral morphine (60 mg) or oxycodone (40 mg)=1. The response evaluated was the dose conversion ratio [transdermal fentanyl/oral morphine or oxycodone (conversion dose to fentanyl)]=Y and was taken to be 0 for Y≤1, 1 for 1<Y≤2, 2 for 2<Y≤3, and 3 for 3<Y. Predictors evaluated were factors potentially impacting pain. Ordered logistic regression analysis was carried out to identify the predictive factors requiring high-dose transdermal fentanyl in opioid switching.
Breast cancer [odds ratio (OR)=8.218; 95% confidence interval (CI), 1.219-55.407; P=0.0305], total protein level (OR=0.630; 95% CI, 0.408-0.974; P=0.0377), alanine aminotransferase level (OR=1.017; 95% CI, 1.001-1.033; P=0.0390), advanced age (OR=3.700; 95% CI, 1.360-10.063; P=0.0104), and male sex (OR=3.702; 95% CI, 1.355-10.115; P=0.0107) were found to be significant predictive factors requiring high-dose transdermal fentanyl in opioid switching.
Our study indicates that breast cancer, total protein, alanine aminotransferase, advanced age, and male sex are significant predictors of a need for higher dose transdermal fentanyl in opioid switching. Our results are considered likely to contribute to the establishment of evidence-based medicine in pain relief and palliative care.
确定在癌症疼痛患者中，从口服吗啡或羟考酮转换为透皮芬太尼时需要高剂量透皮芬太尼的预测因素。
本研究纳入了 2009 年 1 月至 2010 年 6 月在我院接受羟考酮或吗啡控释片转换为透皮芬太尼的 76 例终末期癌症住院患者。转换剂量计算为透皮芬太尼（25μg/h）/口服吗啡（60mg）或羟考酮（40mg）=1。评估的反应是剂量转换比[透皮芬太尼/口服吗啡或羟考酮（转换剂量至芬太尼）]=Y，当 Y≤1 时取 0，1<Y≤2 时取 1，2<Y≤3 时取 2，3<Y 时取 3。评估的预测因素是可能影响疼痛的因素。采用有序逻辑回归分析确定转换为阿片类药物时需要高剂量透皮芬太尼的预测因素。
乳腺癌（比值比[OR]=8.218；95%置信区间[CI]，1.219-55.407；P=0.0305）、总蛋白水平（OR=0.630；95%CI，0.408-0.974；P=0.0377）、丙氨酸氨基转移酶水平（OR=1.017；95%CI，1.001-1.033；P=0.0390）、高龄（OR=3.700；95%CI，1.360-10.063；P=0.0104）和男性（OR=3.702；95%CI，1.355-10.115；P=0.0107）是转换为阿片类药物时需要高剂量透皮芬太尼的显著预测因素。
本研究表明，乳腺癌、总蛋白、丙氨酸氨基转移酶、高龄和男性是转换为阿片类药物时需要更高剂量透皮芬太尼的显著预测因素。我们的结果有助于为疼痛缓解和姑息治疗建立循证医学。
