某安寧療護單位皮下自控式止痛系統之使用

The Use of Subcutaneous Patient-Controlled Analgesia (PCA) in a Palliative Care Unit

蔡麗雲(Li-Yun Tsai) ； 田聖芳(S. F. Tienw) ； 賴允亮(Yuen-Liang Lai) ； 賴裕和(Yeur-Hur Lai) ； 張澤芸(Tse-Yun Change) ； 劉景萍(Liu-Ching Ping) ； 李英芬(In-Fen Li)

《安寧療護雜誌》 7卷1期 (2002/02) Pp. 10-19

https://doi.org/10.6537/TJHPC.2002.7(1).2

摘要

There are over twenty thousand cancer terminal patients in Taiwan every year. Pain is their most distress problem. Patient-Controlled Analgesia (PCA), maintaining the drug concentration in blood, is a safe and effective way to manage cancer pain.
This research was a restropective design. The datas were collected from 1990 February to 1997 February from chart review, totally 115 elderly terminal patients in the palliative care unit of medical center. The purpose of research was to evaluate the titration method and to document the effectiveness and side effect. The results of this study revealed was: (1) PCA is used for dose titration and pain relief. (2) The mean of daily initial morphine doses were from 1.58mg to 2.69mg per hour of the first 14 days, and mean daily total doses of morphine were from 38.2mg to 94.5mg. (3) The reason to terminate PCA included death in 71 out of 115(61.7%), preparation for home care in 23(20%), pain control satisfied and changed to oral morphine in 12(10.4%). The mean morphine doses were 61.2mg, 61.2mg and 31.4mg on the last 24 hours for termination of PCA. (4) Pain scores were 7.2(on a 0 to 10 scale) the day before use PCA, 5.2 after the first day, 4.1 after the second day,3.4 after the third day, significant difference existed(p＜0.001). The top four accompaning side effects were constipation (n=33, 28.7%), drowsiness (n=23, 20%), urine retention (n=6, 5.2%), and nausea/vomiting (n=5, 4.3%). The study indicates that PCA is a safe and effective in pain relief of elderly terminal cancer patients, without severe side effects. This research provides important guidelines and implications to manage cancer pain of hospice/palliative care patients.

並列摘要

There are over twenty thousand cancer terminal patients in Taiwan every year. Pain is their most distress problem. Patient-Controlled Analgesia (PCA), maintaining the drug concentration in blood, is a safe and effective way to manage cancer pain.
This research was a restropective design. The datas were collected from 1990 February to 1997 February from chart review, totally 115 elderly terminal patients in the palliative care unit of medical center. The purpose of research was to evaluate the titration method and to document the effectiveness and side effect. The results of this study revealed was: (1) PCA is used for dose titration and pain relief. (2) The mean of daily initial morphine doses were from 1.58mg to 2.69mg per hour of the first 14 days, and mean daily total doses of morphine were from 38.2mg to 94.5mg. (3) The reason to terminate PCA included death in 71 out of 115(61.7%), preparation for home care in 23(20%), pain control satisfied and changed to oral morphine in 12(10.4%). The mean morphine doses were 61.2mg, 61.2mg and 31.4mg on the last 24 hours for termination of PCA. (4) Pain scores were 7.2(on a 0 to 10 scale) the day before use PCA, 5.2 after the first day, 4.1 after the second day,3.4 after the third day, significant difference existed(p＜0.001). The top four accompaning side effects were constipation (n=33, 28.7%), drowsiness (n=23, 20%), urine retention (n=6, 5.2%), and nausea/vomiting (n=5, 4.3%). The study indicates that PCA is a safe and effective in pain relief of elderly terminal cancer patients, without severe side effects. This research provides important guidelines and implications to manage cancer pain of hospice/palliative care patients.

並列關鍵字

palliative care ； subcutaneous patient-controlled analgesia ； morphine