多元化疼痛管理模式在晚期癌症患者中的 应用与效果评价——基于临终关怀科的整合实践

Application and Effect Evaluation of a Diversified Pain Management Model in Patients with Advanced Cancer—An Integrated Practice Based on the Hospice Care Unit

摘要: 目的：探讨整合个体化药物镇痛、非药物干预及新型镇痛技术的多元化疼痛管理模式在晚期癌症患者中的临床应用效果，为临终关怀科疼痛管理优化提供实践依据。方法：选取本院临终关怀科2024年5月~2025年5月收治的86例晚期癌症疼痛患者，通过G*Power 3.1软件估算样本量(设定α = 0.05，1 − β = 0.80，效应量d = 0.6)，采用随机数字表法分为对照组(42例)与观察组(44例)，实施分配隐藏与盲法评估。对照组实施常规疼痛管理，观察组采用整合药物、非药物及新型技术的多元化疼痛管理模式。比较两组患者干预前、干预2周后、干预4周后及干预结束后1周随访的疼痛程度(NRS评分)、心理状态(SAS、SDS评分)、生活质量(QLQ-C30评分)，同时统计难治性疼痛控制率及不良反应发生率。结果：干预2周、4周后及随访时，观察组NRS评分(1.9 ± 0.7分、1.7 ± 0.6分、1.8 ± 0.6分)、SAS评分(41.8 ± 3.9分、40.2 ± 3.5分、40.5 ± 3.6分)、SDS评分(43.2 ± 4.3分、41.5 ± 4.0分、41.8 ± 4.1分)均显著低于对照组(P < 0.05)；观察组QLQ-C30各维度评分(躯体功能76.2 ± 8.5分、角色功能73.1 ± 9.2分等)、难治性疼痛控制率(92.86%)显著高于对照组(P < 0.05)，不良反应发生率(6.82%)显著低于对照组(21.43%) (P < 0.05)。结论：多元化疼痛管理模式通过药物、非药物及新型技术的协同作用，可有效减轻晚期癌症患者疼痛程度，改善心理状态与生活质量，提升难治性疼痛控制效果且安全性更高，契合临终关怀“减轻痛苦、维护尊严”的核心目标，值得临床推广。

Abstract: Objective: To explore the clinical application effect of a diversified pain management model integrating individualized pharmacologic analgesia, non-pharmacologic interventions and novel analgesic technologies in patients with advanced cancer, and to provide practical evidence for optimizing pain management in the hospice care department. Methods: A total of 86 patients with advanced cancer pain admitted to the hospice care department of our hospital from May 2024 to May 2025 were selected. The sample size was estimated by G*Power 3.1 software (α = 0.05, 1 − β = 0.80, effect size d = 0.6). The patients were divided into a control group (42 cases) and an observation group (44 cases) using the random number table method, with allocation concealment and blind evaluation implemented. The control group received routine pain management, while the observation group was given the diversified pain management model integrating pharmacologic, non-pharmacologic and novel analgesic technologies. The pain intensity (NRS score), psychological status (SAS and SDS scores), quality of life (QLQ-C30 score) of the two groups were compared before intervention, 2 weeks after intervention, 4 weeks after intervention and 1 week after the end of intervention. Meanwhile, the refractory pain control rate and adverse reaction rate were statistically analyzed. Results: At 2 weeks, 4 weeks after intervention and follow-up, the NRS score (1.9 ± 0.7, 1.7 ± 0.6, 1.8 ± 0.6), SAS score (41.8 ± 3.9, 40.2 ± 3.5, 40.5 ± 3.6) and SDS score (43.2 ± 4.3, 41.5 ± 4.0, 41.8 ± 4.1) of the observation group were significantly lower than those of the control group (P < 0.05). The scores of all dimensions of QLQ-C30 in the observation group (physical function: 76.2 ± 8.5, role function: 73.1 ± 9.2, etc.) and the refractory pain control rate (92.86%) were significantly higher than those of the control group (P < 0.05), and the adverse reaction rate (6.82%) was significantly lower than that of the control group (21.43%) (P < 0.05). Conclusion: Through the synergistic effect of pharmacologic agents, non-pharmacologic interventions and novel technologies, the diversified pain management model can effectively alleviate pain intensity, improve psychological status and quality of life in patients with advanced cancer, enhance the control effect of refractory pain with higher safety. It aligns with the core goal of hospice care, which is to relieve suffering and uphold dignity, and is worthy of clinical promotion.