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ABSTRACT OBJECTIVE：To evaluate the effect of pharmacists intervention on opioid treatment and management in outpatients
with cancer pain under multidisciplinary team（MDT）mode. METHODS：Totally 120 outpatients with cancer pain were selected
from outpatient department of our hospital from Jan. 2016 to Dec. 2018，and divided into observation group and control group
according to random number table method，with 60 cases in each group. After 1 month follow-up，patients in the control group
were given opioid analgesics and routine intervention according to pain degree，while patients in the observation group were given
same treatment as control group and pharmacist intervention based on MDT. The pain condition，medication compliance condition，
quality of life（QOL）score，the incidence of ADR and satisfaction degree were observed in 2 groups before and after intervention.
RESULTS：Follow-up were completed in 2 groups. After intervention，NRS scores of 2 groups were significantly lower than before
intervention；the observation group was significantly lower than the control group；medication compliance scores and QOL scores
of 2 groups were significantly higher than before intervention，the observation group was significantly higher than the control group
at the same time. With the prolongation of treatment time，the number of patients with mild pain and general medication
compliance in 2 groups increased gradually，and the observation group were significantly higher than the control group at the same
time；the number of patients with moderate , severe pain and low medication compliance were significantly decreased gradually，
and the observation group was significantly lower than the control group at the same time. The number of patients with good
medication compliance in the observation group was significantly higher than that in the same group before intervention and the
control group at the same time（P＜0.05 or P＜0.01）. There was no significant difference in the incidence of ADR between 2
groups（P＞0.05）. The satisfaction of pain control results，doctors’treatment and pharmacists follow-up in the observation group
were significantly higher than control group（P＜0.05 or P＜0.01）. CONCLUSIONS：Under MDT mode，pharmacists participating
in the management of opioid treatment for cancer pain outpatients can effectively relieve the pain，and improve the medication
compliance and quality of life.
KEYWORDS Multidisciplinary team mode；Outpatient with cancer pain；Opioids；Medication compliance；Life quality；ADR；
Pharmacist

癌痛是恶性肿瘤患者常见的症状之一。在恶性肿 1.1 纳入与排除标准
瘤患者中，癌痛发生率约为 70％～90％，严重影响其生 纳入标准：（1）年龄 20～86 岁；（2）门诊就诊；（3）经
[1]
存质量 。阿片类药物是治疗中、重度癌痛的基础药 病理或细胞学证实为晚期恶性肿瘤；（4）主述存在疼痛，
物。由于门诊癌痛患者需长期用药，因此使用时应首选 且疼痛数字评分（NRS）≥4 分；（5）生存质量受到影响，
[2]
口服给药方式 。但目前尚缺乏统一的针对门诊癌痛患 卡氏评分（KPS）≥70分；（6）预计生存时间≥3个月；（7）
者的标准化诊疗体系 ，癌痛控制不足的现象较普遍 。 应用阿片类药物进行镇痛治疗；（8）表述清楚，意识清
[4]
[3]
国外有研究将多学科协作团队（MDT）诊疗模式应用于 醒，无严重脑、心、肝、肺、肾功能障碍；（9）自愿参加本研
癌痛治疗，并进行了相关探索，该团队中包含了肿瘤、麻 究，并积极配合复诊、回访、癌痛规范化诊疗及阿片类药
醉、疼痛、放疗、介入、外科、护理、药剂等相关科室的专 物治疗管理。
[5]
业人员 。国内也有相关研究证实，MDT模式可有效提 排除标准：（1）非癌痛患者；（2）意识障碍及精神疾
高癌痛的控制水平 。因此，药师作为MDT团队中的一 病者；（3）严重脑、心、肝、肺、肾功能障碍者；（4）不配合
[6]
员，应运用药学专业知识，积极参与癌痛患者的用药监 完成随访者。
护，以提高药师的自身价值。基于此，本研究探讨了我 1.2 资料来源
院药师在MDT模式下参与门诊癌痛患者阿片类药物治 选取2016年1月－2018年12月于我院门诊就诊的
疗管理的作用，旨在为规范门诊癌痛患者用药及癌痛管 癌痛患者，采用随机数字表法分为观察组和对照组，每组
理提供参考。 60例。两组患者性别、年龄、肿瘤类型等基本资料比较，
1 资料与方法 差异均无统计学意义（P＞0.05），具有可比性，详见表1。

表1 两组患者基本资料比较
Tab 1 Comparison of general information of patients in 2 groups
男性/女性， 年龄（x±s）， 肿瘤类型，例（％）
组别 n
例 岁 肺癌 肠癌 胃癌 乳腺癌 肝癌 前列腺癌 肾癌 子宫癌 卵巢癌 其他
对照组 60 42/18 56.2±14.3 21（35.0） 6（10.0） 2（3.3） 1（1.7） 11（18.3） 2（3.3） 2（3.3） 1（1.7） 3（5.0） 11（18.3）
观察组 60 40/20 58.8±12.1 20（33.3） 5（8.3） 3（5.0） 2（3.3） 9（15.0） 4（6.7） 3（5.0） 2（3.3） 3（5.0） 9（15.0）
1.3 干预措施 措施包括药师为两组患者建立随访档案，通过电话、QQ
对照组患者根据疼痛程度选择阿片类药物+常规干 或微信群互动平台等方式随访并提醒患者及时复诊，随
预，观察组患者给予对照组治疗+MDT干预。常规干预 访时间为 1 个月。MDT 干预措施包括药师为患者及其

中国药房 2020年第31卷第6期 China Pharmacy 2020 Vol. 31 No. 6 ·751 ·