말기 암으로 입원한 환자에서 진통제 사용의 실태

Abstract

Background : Pain is the most common complaint in hospitalized terminal cancer patients, therefore, controlling the pain is important problem. The studies showed that 33%~60% of patients with advanced cancer were alert during the last 24 hours of life, and the majority of patients were able to continue oral medication until death. The study look at the analysis of analgesic use, both oral and parenteral, in hospitalized terminal cancer patients.

Methods : A retrospective chart review of analgesic type and amount was performed on the medical records of 194 hospitalized terminal cancer patients who had died in Yong Dong Serverance Hospital during the period of January 1, 1993 to December 31, 1994. Different types and amounts of analgesic were converted to a common standard : an oral morphine equivalant(OME) relative to 1mg of oral morphine. Associations between analgesic used and selected patient characteristics(age, sex, cancer site, pain, diet, mental status, and types, amount, and adminstration route of analgesic) were explored.

Results : The mean age f patients was 60.44±14.26 years. The total number of patients was 194, male, 132 cases(68%) and the female, 62 cases(32%). The frequent cancer site was liver(29.4%), lung(19.1%), stomach(17.0%), in order. There was no descriptive statistical significance between dosages of analgesic and age, sex, and cancer site. 93 patients(47.9%) were well oriented 24 hours prior to death, 54 patients(27.8%) 6 hours prior to death, and 17 cases(8.8%) 1 hour prior to death. 152 out of 194 patients(59.3%) complained pain, and 115 out of 152 patients were treated with analgesic to relieve pain. 86 out of 115 patients were able to continue on oral medication. 59 cases(51.3%) were given regularlly, 32 cases(27.8%) p.r.n.(pro re nata), and 24 cases(20.9%) regularlly and p.r.n.. 20 cases(17.4%) were took oral medication only, 71 cases(61.7%) were given parenteral injection. 72 out of 93 patients(77.4%) with an alert mental status had required analgesics during the last 24 hours prior to death, and 31 cases(43.1%) were given oral medication, and 56 cases(77.8%) were given parenteral injection, also 24 hours prior to death.

Conclusion : In this study, 152 out of total 194 patients(78.4%) complained pain before die of cancer. 115 patients(75.7%) were given anagesics to control pain and order, 83 patients(72.2%) were received regular analgesic prescritpion. Parenteral injection analgesics were much more frequen-tly used than oral medication to control pain in hospitalized terminal cancer patients, even through the cases of patients were able to take oral medication and had an alert mental status during the 24 hours before death.