ABSTRACT
Objective To investigate the clinical efficiency,safety,adverse reactions and healthrelated life quality of transdermal fentanyl patches for pain management in terminal cancer patients with hepatic and renal dysfunction and ascites.Methods 98 terminal cancer patients with moderate to serve pain combined with abnormal hepatic and renal dysfunction were randomly divided into two groups.Group Ⅰ (n=56)received transdermal fentany patches.Group Ⅱ,the control group (n=42),received morphine controlledrelease tablets.Terms of pain intensity,function of renal and liver,adverse reactions and heath-related quality of life were assessed before and after treatment.Results Patients were satisfied with their pain management in both groups,and no significant difference in pain release was observed between the groups (x2 =0.01,0.07,0.01,0.04,P ＞ 0.05).The incidences of constipation and dysuresia were significantly less in the group Ⅰ compared with that of the group Ⅱ (x2 =7.32,3.96,P ＜ 0.05).The incidences of hypersomnia,dizzy,nausea and vomiting were similar betwecn the two groups (x2 =0.12,0.54,0.54,0.02,P ＞ 0.05).Most of the adverse reactions would relieve or disappear after symptomatic treatment.Values of BUN,CR,ALT,AST were similar before and after treatment in group Ⅰ (t =1.43,1.67,0.91,0.11,P＞ 0.05).However,in group Ⅱ,these values were significantly increased after treatment (t =17.59,49.17,42.12,36.23,P ＜ 0.05).The heathrelated life quality (appetite,spirit,somnus,fatigue,daily life and countenance) were significantly improved after treatment in both groups (the group Ⅰ t =3.37,4.40,2.07,5.66,4.48,P ＜ 0.05; the group Ⅱ t =2.03,2.27,3.59,4.16,2.79,P ＜ 0.05),the spirit group Ⅰ improved more obviously compared with group Ⅱ (t =2.93,P ＜ 0.05).Conclusion Transdermal fentanyl patches provides equal pain relief compared with Morphine controlled-release tablets in the terminal cancer patients with abnormal hepatic and renal function and ascites.Transdermal fentanyl patches significantly improve health-related quality with less hepatic and renal function influence and low incidence of adverse reaction.It should be recommended in the treatment terminal cancer patients with moderate to serve pain combined with abnormal hepatic and renal function and ascites.