鞘内连续输注吗啡治疗顽固性癌痛的疗效观察

[1] van den Beuken-van Everdinge MH,de Rijke JM,Kessels AG,etal.Prevalence of pain in patients with cancer: a systematic review of the past 40 years[J]. Ann Oncol, 2007,18(9):1437-1449.

摘要:

目的 观察鞘内连续输注吗啡在顽固性癌痛中的疗效。方法 观察我院顽固性癌痛患者50例,且患者生存期≥1月,分为对照组和治疗组。A组(对照组)为口服吗啡类片剂镇痛治疗；B组(治疗组)为鞘内连续输注吗啡镇痛治疗。记录两组患者在治疗1d、3d、5d、10d、15d、30d的疼痛评分、爆发痛次数、满意度及生活质量评分、药物不良反应等(恶心、呕吐、腹胀、便秘、尿潴留、嗜睡、瘙痒、呼吸抑制、成瘾性),并观察鞘内连续输注吗啡的安全性、舒适性。结果 与A组比较,B组使用鞘内连续输注吗啡后1d、3d、5d、10d、15d、30d 后数字模拟评分Numerical Rating Scale(NRS)评分均明显降低(P <0.05)；夜间爆发痛明显降低(P <0.05)。与A组相比较,B组患者满意度、日常生活能力(ADL)Barthel(BI)评分升高(P<0.05)。与A组相比较,B组患者的药物不良反应明显少于A组(P <0.05)。结论：鞘内连续输注吗啡在顽固性癌痛患者中的疗效确切,可以减少吗啡总用量,提高患者的生活质量,减少药物的不良反应。

Abstract:

Objective To evaluate the efficacy of continuous intrathecal infusion of morphine (CIIM) on the intractable cancer pain. Methods Observing 50 patients with intractable cancer pain in our hospital with patient survival more than one month. Control and treated groups, labelled as A and B, are employed for the research, with A providing with tablets for oral morphine analgesia and B with CIIM. Key indicators, including pain scores, pain outbreaks, life satisfaction and quality, adverse drug reactions (Nausea, vomiting, bloating, constipation, urinary retention, drowsiness, itching, respiratory depression, and addiction), have been recorded and compared after the treatment with 1d、3d、5d、10d、15d、30d, together with an evaluation of the safety and comfort. Results With respect to Group A, Group B presents lower numerical rating scale and night pain breakthrough, but notably higher scores for life satisfaction and daily activity, together with decreased adverse drug reactions. Conclusion CIIM brings curative effect for intractable cancer pain, resulting in lower morphine usage, better life quality and reduced adverse reactions.