小剂量氯胺酮辅助吗啡皮下自控镇痛治疗顽固性中/重度晚期癌痛  

Analgeic effect of patient control subcutaneous morphine combined with small-dose ketamine on moderate/severe terminal cancer pain

作　　者：陈付强[1] 胡丹[1] 时飞[1] 谢平[1] 王昕[1] 

机构地区：[1]青岛市市立医院疼痛科,山东青岛266011

出　　处：《中国癌症杂志》2008年第11期854-856,共3页China Oncology

摘　　要：背景与目的:疼痛是晚期癌症患者最主要的症状,也是影响癌症患者晚期生活质量的主要问题,如何治疗顽固性中/重度晚期癌痛,同时不增加不良反应的发生率是癌痛治疗的最大难题。本研究观察小剂量氯胺酮辅助患者吗啡皮下自控镇痛(PCSA)对顽固性中、重度晚期癌痛患者的可行性及镇痛疗效。方法:选择52例中/重度晚期癌症疼痛患者,均为经三阶梯药物方案治疗未能很好控制疼痛、同时药物毒副作用较大的患者。按入院前后随机分成两组,分别采用PCSA吗啡(对照组)和小剂量氯胺酮联合吗啡PCSA(观察组)对患者进行镇痛治疗。两组均采用PCSA方法,镇痛液两组均为100 ml,对照组内含吗啡80 mg+2%利多卡因20 ml+氟哌利多2.5mg+0.9%氯化钠溶液共计100 ml。观察组内含吗啡40 mg+2%利多卡因20 ml+氟哌利多2.5 mg+0.9%氯胺酮200 mg+0.9%氯化钠溶液共计100 ml。采用上海博创电子泵,负荷量为10 ml,背景剂量均为每小时2 ml,患者自控镇(PCA)为3 ml,锁定时间为15 min。分别在安装止痛泵后30 min、1、3、5、24、48 h采用视觉模拟评分法(VAS)评估疼痛程度,统计两组不良反应发生率。结果:经治疗,两组病例疼痛基本缓解。两组VAS各时段差异无显著性(P>0.05)。但PCA按压次数与吗啡用量对照组显著多于观察组;后者生活总满意度显著高于前者。不良反应:恶心呕吐、便秘、嗜睡、皮肤瘙痒对照组显著高于观察组;呼吸抑制、幻觉发生率两组间差异无显著性(P>0.05)。结论:经皮下小剂量氯胺酮辅助吗啡PCSA具有镇痛作用强、不良反应小、方法简便等优点,适合治疗中/重度晚期顽固性癌痛。Background and purpose： The pain is not only the chief symptom of cancer but also the main factor of survival quality for the cancer patient.So it is the most difficult for how to control the pain of moderate to severe late-stage cancer and reduce the rate of side effects.We observed the analgesia effects of micro-dosage ketamine associating morphine patient control skin analgesia（PCSA） for latter cancer pain patients. Methods： 52 cases middle, latter cancer pain patients were divided two groups randomly, the first group used the morphine PCSA and the second group used micro-dosage ketamine associating morphine PCSA. The VAS（Visual Analogue Scale） was used to evaluate the pain level, then statistic the side effects rate of two groups. Results： Two groups patients＇pain all alleviated fundamentally, the VAS of every period have not statistic difference, but the PCSA pressing times in the first group was more than in the second group. The second group patients＇life satisfactory rate was higher obviously than the first group patients＇;Side effects： the incidence of nausea, vomiting,indulge in sleep and skin titillation in the first group was higher than in the second group; the incidence of respiration depression and hallucination had not difference between two groups. Conclusion： Micro-dosage ketamine associating morphine patient control skin analgesia（PCSA）approach appears to provide patient with safe and effective pain relief and reduce side-effect for moderate to severe late-phase cancer pain ,easy to perform and have no process complication to used in clinic.

关 键 词：吗啡 氯胺酮 镇痛 病人控制 癌痛 

分 类 号：R614.42[医药卫生—麻醉学] R719.8[医药卫生—外科学]