目的观察奥氮平联合阿片类药物治疗癌性疼痛的疗效和安全性。方法回顾性分析海军军医大学附属长征医院 肿瘤科2018年1月至2020年8月使用阿片类药物治疗的76例癌性疼痛患者的临床资料，其中男性41例，女性35例，按奥氮平使 用剂量分为4组，分别为10mg/d组（6例）、5mg/d组（26例）、2.5mg/d组（24例）和对照组（20例），分析治疗1周后数字分级评分 法（NRS）评分的变化和不良反应发生情况。结果6例10 mg/d奥氮平治疗患者出现3级嗜睡4例、3级乏力2例、3级便秘1例， 终止该组治疗。治疗1周后，5 mg/d奥氮平组、2.5 mg/d奥氮平组、对照组NRS评分分别（3.9±1.5）分、（3.5±1.4）分、（4.8±1.0）分， 5 mg/d 奥氮平组与对照组比较差异有统计学意义（P＝0.032），2.5 mg/d 奥氮平组与对照组比较差异也有统计学意义（P＝ 0.002），5 mg/d奥氮平组与2.5 mg/d奥氮平组比较差异无统计学意义（P＝0.364）。结论5 mg/d和2.5 mg/d奥氮平联合阿片类 药物治疗癌性疼痛可以明显降低NRS评分，提高癌痛治疗效果。

Objective To assess the efficacy and safety of a combination of Olanzapine and strong opioid drugs in treating cancer pain. Methods Clinical data of patients with cancer pain treated with strong opioids from January 2018 to August 2020 in Department of Oncology, Changzheng Hospital, Naval Military Medical University were retrospectively analyzed. Patients were divided into 4 groups according to the dose of olanzapine they received: group 10 mg/d, group 5 mg/d, group 2.5 mg/d and the control group. The change in NRS score of cancer pain after 1⁃week treatment was assessed. Adverse events (AEs) monitoring occurred throughout.Results Among the 6 patients who received Olanzapine 10 mg/d, 4 patients experienced 3⁃grade drowsiness, 2 patients experienced 3⁃grade fatigue, 1 patient experienced 3⁃grade constipation. This group was discontinued owing to the AEs. After 1⁃week treatment, the NRS score of the 3 groups were 3.9±1.5、3.5±1.4、4.8±1.0 for group 5 mg/d olanzapine 2.5 mg/d olanzapine and control group respectively. In the study, treatment with 5 mg/d olanzapine, compared with Control group, resulted in statistically significant improvement（P＝0.032）. Treatment with 2.5 mg/d olanzapine, compared with Control group, also resulted in statistically significant improvement（P＝0.002）. Treatment with 5 mg/d olanzapine, compared with Treatment with 2.5 mg/d olanzapine, didn′t result in any statistically significant improvement（P＝0.364）. Conclusion Treatment with a combination of 10 mg/d and 5 mg/d olanzapine with strong opioid drugs can significantly reduce the NRS score, improve the efficacy of cancer pain.