恶性肠梗阻 (malignant bowel obstruction, MBO)指原发性或转移性恶性肿瘤造成的肠道梗阻,是晚期肿瘤常见的并发症,通常合并炎性水肿、电解质紊乱、肠道动力异常、肠道菌群失调及药物不良反应等因素,从而使病情进一步复杂及恶化.对于终末期恶性肿瘤合并 MBO 病人,剧烈的持续腹痛是影响其生活质量的最重要因素之一.专家共识 [1] 推荐使用阿片类药物(吗啡、芬太尼等)和抗胆碱药物(氢溴酸东莨菪碱、山莨菪碱等)用于镇痛治疗,在临床实践中有时镇痛效果并不理想.经过查阅资料,发现吗啡阿托品注射液(含盐酸吗啡 10 mg,硫酸阿托品 0.5 mg)用于麻醉和手术前给药可加强麻醉药的效力,并减少病人手术前的恐怖与诱导期不适,遂尝试其在终末期恶性肿瘤合并 MBO 能否达到更为理想的镇痛效果.本研究收集 48 例终末期 MBO 病人,对其镇痛治疗进行分析.

Objective To investigate the effect of pregabalin combined with transdermal fentanyl in the treatment of pain caused by dvanced squamous cell carcinoma of head and neck(SCCHN).Methods A total of 32 patients with advanced SCCHN were randomly divided into two groups.Sixteen cases in the control group received transdermal fentanyl only,the dosages were gradually adjusted until the numerical rating scales (NRS) ≤3;and other cases in the combined group,pregabalin was co-administered with transdermal fentanyl,similar to the control group,150 mg of pregabalin was administered twice a d ay.NRS,dosages of transdermal fentanyl and side effects were evaluated before treatment and at one,two,four and eight weeks after the treatment,respectively.Results After treatment,the average NRS decreased more significant in the combined group than that in the control group (P＜0.05).The dosage of transdermal fentanyl and the side effects in the combined group were less than those in the control group(P＜0.05).Conclusion Pregabalin combined with transdermal fentanyl is effective for the treatment of pain caused by advanced SCCHN with less adverse reaction.

Objective To observe the efficacy and toxicity of second-line treatment of irinotecan combined with lobaplatin for extensive small cell lung cancer ( SCLC ) . Methods 46 cases of SCLC patients were selected and given irinotecan 200 mg/m2 into the normal saline 250 mL, diluted and then intravenous dripped for 1. 5 h on the first day;lobaplatin 30 mg/m2 into 5% glucose 500 mL, diluted and then intravenous dripped for 2 h on the first day. 21 d was 1 cycle. After two cycles of treatment, the efficacy and adverse reac-tions were evaluated. Results 46 cases could be evaluated. There were 1 case of complete remission ( CR ) , 15 cases of partial remis-sion ( PR ) , 19 cases of stable disease ( SD ) , 11 cases of progressive disease ( PD );the objective response rate ( ORR ) was 34. 78%, the disease control rate ( DCR ) was 76. 09%;the median progression-free survival ( PFS ) was 4. 6 months, and the median survival ( OS ) was 7. 8 months. Adverse reactions were hematologic toxicity and gastrointestinal reactions. Conclusion Irinotecan combined with lobaplatin program for the treatment of relapsed SCLC has a good effect but also larger toxicity, which is worthy of further study.

Objective To evaluate the short-term curative effect of bevacizumab in combination with irinotecan for recurrent cerebral glioma.Methods Fourteen cases of recurrent cerebral glioma were enrolled in this study.To observe the clinical efficacy and adverse reactions,all the patients received Bevacizumab(5mg/kg,iv,d1)and irinotecan(120mg/m2,iv,d2),14 days was a cycle.Results All of the 14 cases,there were 5 cases with partial remission(35.7%),7 cases with stable disease(50%)and 2 cases with progressive disease(14.3%).The follow up 6-month progression-free survival rate was 71.4%(10/14),and all patients could be tolerated with a lighter adverse reaction,Conclusion Bevacizumab in combination with irinotecan is effective in the treatment of recurrent cerebral glioma with a mild side effect.

10.3969/j.issn.1000-8179.2013.12.011

脑胶质细胞瘤是成年人中最常见的原发中枢神经系统恶性肿瘤,占总数的50％～60％,其中以胶质母细胞瘤恶性程度较高[1].脑胶质瘤发病率虽仅占全身恶性肿瘤的3％～5％,但因治疗手段有限、肿瘤生物学行为多样且呈浸润性生长,预后差、平均生存期短.

Objective To investigate the adverse effects of opioids for elderly patients with moderate to severe cancer pain.Methods The adverse effects of 100 elderly cancer patients with moderate to severe pain treated by opioids were analyzed retrospectively.Faces pain scale and numeric rating scale were used to assess pain intensity.Patients who used opioids initially started to titrate from small dose,and those who used opioid drugs before and did not acquire satisfactory analgesic effect,started with the dose according to opioids dose conversion.Daily pain intensity,location,nature and adverse reactions were recorded regularly.Results The median medication time was 50d,median opioids dose(converted to morphine dose) was 60mg in these 100 patients.93%(93/100) patients achieved more than moderate ease.The incidence of adverse reactions was 61%(61/100) in these of patients.Constipation(48%) is the most common clinical adverse effect,followed by nausea/vomiting(24%).Lethargy(12%),dizziness(5%),skin itching(5%),dysuria(4%),and respiratory depression(2%) was rare adverse reaction.Conclusion The opioids can effectively release the cancer pain of elderly patients,the main adverse effects were constipation and nausea/vomiting.

<正>【病例】男,49岁。因腹痛伴柏油样便1个月入院。1个月前无明显诱因出现间断上腹痛,以饥饿痛为主,每天排柏油样便1或2次,并有乏力、头晕,无发热、呕血等,当地医院胃镜检查示胃底活动性出血(不除外胃底静脉曲张)。超声检查示:肝脏实质弥漫性病变,脾大,门