右美托咪啶复合吗啡静脉自控镇痛用于晚期难治性癌痛患者的临床研究

CLINICAL STUDY OF PATIENT-CONTROLLED INTRAVENOUS ANALGESIA WIHT DEXMEDETOMIDINE AND MORPHINE IN TREATMENT OF REFRACTORY CANCER PAIN

摘要:

目的 探讨右美托咪定联合吗啡静脉患者自控镇痛(patient-controlled intravenous analgesia,PCIA)用于晚期难治性癌痛患者的效果及安全性。方法 选取晚期难治性癌痛患者119例,随机分为吗啡组(59例)和右美托咪定组(简称右美组,60例),吗啡组单纯使用吗啡注射剂,右美组使用吗啡联合右美托咪定注射剂,所有患者均采用PCIA给药。记录或评估PCIA前,PCIA后1d、2d、10d、20d和30d患者的疼痛数字评分(numerical rating scale, NRS)、吗啡及右美托咪定的使用剂量、患者的生活质量、满意度和不良反应。结果：PCIA治疗后两组患者的NRS评分在各个时间段均显著低于治疗前(P＜0.01),而在同一时间段两组患者的NRS评分无显著性差异。随着治疗时间的延长,两组患者使用吗啡剂量逐渐增多(P＜0.05),但PCIA治疗后的各个时间点,右美组所需的吗啡剂量显著低于吗啡组(P＜0.01)。随着治疗时间的延长,右美托咪定的注射量逐渐升高,在PCIA治疗2d后的各个时间点,右美托咪定的增幅不显著。与PCIA前相比,两组患者PCIA治疗2d、10d、20d和30d的生活质量得分和满意度得分均显著改善(P＜0.01),两组患者之间无显著性差异。PCIA后,两组患者便秘和恶心呕吐的人数逐渐增加,并且在PCIA治疗2d时出现嗜睡的副作用,而右美组便秘、恶心呕吐和嗜睡的发生率显著低于吗啡组。结论 右美托咪定联合吗啡PCIA治疗晚期难治性癌痛可以明显的改善患者的疼痛和生活质量,减少吗啡的用量,降低患者的不良反应发生率,是晚期难治性癌痛WHO三阶梯药物治疗以外的一种良好的辅助治疗方法,值得临床推广应用。

Abstract:

Objective To investigate the efficacy and safety of dexmedetomidine combined with morphine in patients with advanced refractory cancer pain by patient-controlled intravenous analgesia (PCIA). Methods 119 patients with severe cancer pain were randomly divided into morphine group (59 cases) and dexmedetomidine group (60 cases). Morphine group was injected with morphine. Dexmedetomidine group was injected with morphine and dexmedetomidine. All patients were treated with an electronically controlled analgesia pump. The patient"s numerical rating scale (NRS) score, the dose of morphine and dexmedetomidine, quality of life, satisfaction, and adverse reactions were investigated. Results: After PCIA treatment, the NRS scores of the two groups were significantly lower than those before treatment (P<0.01). At the same time, there was no significant difference in NRS score between the two groups. The dose of morphine that were used in two groups gradually increased with the prolongation of treatment time (P<0.05). However, at each time point after PCIA treatment, the dose of morphine in dexmedetomidine group was significantly lower than that of the morphine group (P < 0.01). With the prolongation of treatment time, the dose of dexmedetomidine gradually increased, and the increase of dexmedetomidine was not significant at various time points after PCIA 2 days treatment The quality of life scores and satisfaction scores of the two groups of patients treated were higher than those before treatment (P<0.01), but there was no significant difference between the two groups. After PCIA, the number of constipation and nausea and vomiting increased gradually in both groups, and side effects of drowsiness occurred at 2 days after PCIA treatment, while the incidence of constipation, nausea, vomiting, and lethargy was significantly lower in the dexmedetomidine group than those in the morphine group. Conclusion Dexmedetomidine combined with morphine can significantly improve the pain and quality of life of patients, reduce the amount of morphine, thereby reducing the incidence of adverse reactions in patients with advanced refractory cancer pain by PCIA. PCIA is a good adjuvant method that is worthy of clinical application.