小剂量氯胺酮辅助吗啡皮下自控镇痛用于晚期癌痛治疗

ANALGESIC EFFECT OF PATIENT-CONTROLLED SUBCUTANEOUS MORPHINE COMBINED WITH SMALL-DOSE KETAMINE ON TERMINAL CANCER PAIN

摘要:

目的：观察小剂量氯胺酮辅助吗啡皮下自控镇痛(PCSA)用于晚期癌痛患者的止痛效果。方法：选择18例中、重度晚期癌痛病人，随机分成两组，分别采用PCSA吗啡(I组)和小剂量氯胺酮联合吗啡PCSA(11组)方法用于以上患者的镇痛。两组均采用皮下自控镇痛方法，镇痛液两组均为100ml，Ⅰ组内含吗啡40mg 2％利多卡因20ml 氟哌利多2．5mg 0．9％生理盐水共计100ml。Ⅱ组内含吗啡20mg 2％利多卡因20ml 氟哌利多2．5mg 氯胺酮200mg 0．9％生理盐水共计100ml。分别在安装止痛泵后30分、1小时、3小时、5小时、24小时、48小时采用视觉模拟评分法(VAS)评估疼痛程度，统计两组不良反应的发生率。结果：经治疗，两组病例疼痛基本缓解。两组视觉模拟评分(VAS)各时段无统计学差异。但PCA按压次数和吗啡用量Ⅰ组明显多于Ⅱ组；Ⅱ组生活总满意度明显高于Ⅰ组。不良反应：恶心呕吐、便秘、皮肤瘙痒Ⅰ组明显高于Ⅱ组；呼吸抑制、幻觉发生率两组无差异。

Abstract:

Objective: To observe the analgesic effect of Patient Control Subcutaneous Analgesia(PCSA) with low dose ketamine and morphine for late phase cancer pain patients. Methods: Eighteen patients with moderate to severe late phase cancer pain were randomly divided into two groups. They were treated with morphine PCSA or low dose ketamine plus morphine PCSA, respectively. The VAS (Visual Analogue Scale) of pain scores and the rate of side effects were also evaluated. Result: Pain in both groups were largely alleviated, but the times of pressing in morphine group was more than that in morphine plus ketamine group. There was no significant difference in VAS pains scores in each period. The patients' life satisfactory rate in the second group was higher obviously than that in the first group. The incidence of nausea, vomiting and skin titillation in the first group was higher than in the second group. There was no difference in the incidence of respiration depression and hallucination between two groups.