Patients with refractory cancer pain often have dysphagia, which increases the difficulty of treatment. Patient-controlled intravenous analgesia (PCIA) is a measure that can achieve sustained, effective and safe analgesia.

To investigate the efficacy and safety of PCIA with hydromorphone, sufentanil or morphine in treatment of refractory cancer pain with dysphagia.

A total of 102 patients with refractory cancer pain and dysphagia were selected from Department of Oncology and Hospice Care Center of the Second Hospital of Wuhan Iron and Steel (Group) Corporation from May 2020 to January 2022, and equally divided into hydromorphone PCIA group, sufentanil PCIA group and morphine PCIA group single-blindly and randomly. The Numerical Rating Scale (NRS) score, the frequency of episodes of breakthrough pain, the Morphine Equivalent Daily Dose (MEDD) , Pittsburgh Sleep Quality Index (PSQI) score, Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) score and the incidence of adverse reactions were compared among the three groups before and after treatment.

The participants included 51 males and 51 females, with an average age of (60.2±6.3) years. There were no statistical differences in sex ratio, average age, degree of pain, NRS score, MEDD, distribution of primary cancer type, pain type and TNM classification of cancers among the three groups (P>0.05) . The NRS score and the frequency of episodes of breakthrough pain in three groups deceased significantly after treatment (P<0.05) . The type and time of treatment had interactive effects on both the NRS score and the frequency of episodes of breakthrough pain (P<0.05) . The type of treatment produced main effect on the NRS score and the frequency of episodes of breakthrough pain, so did the time of treatment (P<0.05) . The NRS score and the frequency of episodes of breakthrough pain of hydromorphone PCIA group were significantly lower than those of each of other two groups after 24 hours or 72 hours of treatment (P<0.05) . Morphine PCIA group had higher NRS score than other two groups (P<0.05) , and had higher frequency of episodes of breakthrough pain than hydromorphone PCIA group (P<0.05) after one-week treatment. Morphine PCIA group had higher NRS score and frequency of episodes of breakthrough pain than each of other two groups after two-week or one-month treatment (P<0.05) . After one-month treatment, all groups demonstrated increased MEDD and decreased PSQI (P<0.05) . In particular, morphine PCIA group had higher MEDD than other two groups (P<0.05) . Sufentanil PCIA group had higher MEDD than hydromorphone PCIA group (P<0.05) . Morphine PCIA group had higher PSQI score than other two groups (P<0.05) . All groups demonstrated increased score of each item of the QLQ-C30 (P<0.05) . In particular, morphine PCIA group ranked bottom in terms of the score of each item of the QLQ-C30 (P<0.05) . The emotional function score of sufentanil PCIA group was significantly lower than that of hydromorphone PCIA group (P<0.05) . The incidence of adverse reactions had no significant differences among the three groups after one-month treatment (P>0.05) .

For patients with refractory cancer pain and dysphagia, hydromorphone and sufentanyl were superior to morphine for PCIA in terms of reducing pain and the frequency of episodes of breakthrough pain, improving quality of sleep and life. But hydromorphone was superior to sufentanyl in quick onset, and effective improvement of emotion with reduced dose of opioid and without increased incidence of adverse reactions.

难治性癌痛患者常伴有口服困难，增加了治疗难度，患者静脉自控镇痛（PCIA）可实现持续、有效及安全镇痛。

探讨氢吗啡酮、舒芬太尼及吗啡在难治性癌痛合并口服困难患者PCIA中的疗效及安全性。

选取武汉钢铁（集团）公司第二职工医院肿瘤科及安宁疗护中心2020年5月至2022年1月收治的102例难治性癌痛合并口服困难患者为研究对象。将102例患者按随机数字表法分为三组：氢吗啡酮PCIA组、舒芬太尼PCIA组、吗啡PCIA组，各34例。比较三组患者治疗前后的疼痛数字评分表（NRS）评分、爆发痛发作次数、每日等效口服吗啡剂量（MEDD）、匹兹堡睡眠质量指数（PSQI）评分、癌症患者生命质量测定量表（QLQ-C30）评分及不良反应发生率。

102例难治性癌痛合并口服困难患者中男51例、女51例，平均年龄（60.2±6.3）岁。三组患者性别、年龄、疼痛程度、NRS评分、MEDD、原发肿瘤类型、疼痛类型、TNM分期比较，差异均无统计学意义（P>0.05）。与治疗前相比，三组患者治疗后NRS评分、爆发痛发作次数均降低，组别与时间对NRS评分、爆发痛发作次数均存在交互作用（P<0.05）；组别及时间分别对NRS评分、爆发痛发作次数主效应显著（P<0.05）；其中治疗后24 、72 h，氢吗啡酮PCIA组患者NRS评分、爆发痛发作次数均低于舒芬太尼PCIA组和吗啡PCIA组（P<0.05）；治疗后1周，氢吗啡酮PCIA组与舒芬太尼PCIA组患者NRS评分均低于吗啡PCIA组（P<0.05），氢吗啡酮PCIA组患者爆发痛发作次数低于吗啡PCIA组（P<0.05）；治疗后2周、1个月，氢吗啡酮PCIA组与舒芬太尼PCIA组患者NRS评分、爆发痛发作次数均低于吗啡PCIA组（P<0.05）。与治疗前相比，三组患者治疗后1个月MEDD均升高（P<0.05），PSQI评分均降低（P<0.05）；治疗后1个月，吗啡PCIA组患者MEDD高于氢吗啡酮PCIA组和舒芬太尼PCIA组（P<0.05），舒芬太尼PCIA组患者MEDD高于氢吗啡酮PCIA组（P<0.05）；治疗后1个月，吗啡PCIA组患者PSQI评分均高于氢吗啡酮PCIA组和舒芬太尼PCIA组（P<0.05）。与治疗前相比，三组患者治疗后1个月QLQ-C30各项生活质量评分均升高（P<0.05）；治疗后1个月，吗啡PCIA组患者QLQ-C30各项生活质量评分均低于氢吗啡酮PCIA组和舒芬太尼PCIA组（P<0.05），舒芬太尼PCIA组患者情绪功能评分低于氢吗啡酮PCIA组（P<0.05）。治疗后1个月，三组患者各项不良反应发生率比较，差异均无统计学意义（P>0.05）。

对难治性癌痛合并口服困难患者使用PCIA，相比吗啡，氢吗啡酮、舒芬太尼均能更有效地降低疼痛评分、减少爆发痛发作次数、改善睡眠、提高生活质量，但氢吗啡酮比舒芬太尼起效更快，在改善情绪方面效果更佳，阿片类药物用量更低，不良反应发生率也无增加。