Şenel Gülçin, Oğuz Gonca, Koçak Nesteren, Karaca Şerife, Kaya Menşure, Kadıoğulları Nihal
Department of Anesthesiology and Reanimation, Algology and Palliative Care Clinic, Dr. Abdurrahman Yurtarslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
Agri. 2016 Oct;28(4):171-176. doi: 10.5505/agri.2016.07830.
Pain is one of the most important symptoms in palliative care, and has a major impact on the quality of life of cancer patients. In developing countries, difficult access to opioids and the lack of well-established palliative care organizations result in undertreatment of pain. Turkey is one of the countries with statistical evidence of inadequate morphine consumption per capita. In 2010, the adequacy of opioid analgesic consumption was only 7%, based on a per capita consumption of 14.31 mg morphine equivalents. The present study analyzed and described patterns of opioid use among cancer patients in the palliative care clinic.
The data of 418 cancer patients who received palliative care at the palliative care clinic in 2014 were evaluated retrospectively.
Of the total, 183 (44%) of the patients studied were female and 235 (56%) were male. Age ranged from 18 to 93 years (61±15 years). No opioids had been prescribed for 9% of patients, 26% of patients were using weak opioids, and 65% were using strong opioids. Daily oral morphine equivalent dosage per patient was 172±58 mg (range: 40-328 mg). Indications for opioid use were pain (61%), dyspnea (19%), and both dyspnea and pain (20%).
Although there is a limited variety of opioids currently available in this country, it is thought that a more effective and adequate level of pain management can be obtained through education of health practitioners about pain management and opioid use. The relatively high incidence of weak opioid use may be associated with the lack of available rapid release opioids in the country.
疼痛是姑息治疗中最重要的症状之一，对癌症患者的生活质量有重大影响。在发展中国家，难以获得阿片类药物以及缺乏成熟的姑息治疗组织导致疼痛治疗不足。土耳其是人均吗啡消费量不足有统计证据的国家之一。2010年，基于人均14.31毫克吗啡当量的消费量，阿片类镇痛药物的充足率仅为7%。本研究分析并描述了姑息治疗门诊癌症患者的阿片类药物使用模式。
回顾性评估了2014年在姑息治疗门诊接受姑息治疗的418例癌症患者的数据。
在研究的患者中，共有183例（44%）为女性，235例（56%）为男性。年龄范围为18至93岁（61±15岁）。9%的患者未开具阿片类药物，26%的患者使用弱阿片类药物，65%的患者使用强阿片类药物。每位患者每日口服吗啡当量剂量为172±58毫克（范围：40 - 328毫克）。使用阿片类药物的指征为疼痛（61%）、呼吸困难（19%）以及呼吸困难和疼痛两者兼有（20%）。
尽管该国目前可用的阿片类药物种类有限，但通过对医护人员进行疼痛管理和阿片类药物使用方面的教育，认为可以获得更有效和充分的疼痛管理。弱阿片类药物使用相对较高的发生率可能与该国缺乏速效阿片类药物有关。
