小剂量氯胺酮辅助吗啡硬膜外自控镇痛治疗顽固性中、重度晚期癌痛  

Small dosage ketamine associating morphine patient control epidural analgesia(PCEA) in the management of moderate and severe pain in advanced cancer patients

作　　者：陈付强[1] 胡丹[1] 时飞[1] 谢平[1] 王昕[1] 艾登斌[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》2009年第5期377-379,共3页China Oncology

基　　金：青岛市市南区科技局立项资助课题(项目编号:2008035)

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吗啡硬膜外自控镇痛(patient control epidural analgesia,PCEA)用于顽固性中、重度晚期癌痛患者的可行性及止痛效果。方法:选择56例中、重度晚期癌痛患者,均为经三阶梯药物治疗方案治疗未能很好控制疼痛,同时不良反应较大的患者。按入院前后随机分成2组,分别采用PCEA吗啡(A组)和小剂量氯胺酮联合吗啡PCEA(B组)方法镇痛。2组均采用PCEA方法,镇痛液2组均为200ml,A组内含吗啡20mg,B组内含吗啡20mg,氯胺酮100mg。采用上海博创电子泵,负荷量为5ml,背景剂量均为2ml/h,PCA为2ml,锁定时间为15min。分别在安装止痛泵后24、48h采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度,统计2组不良反应发生率。结果:经治疗,2组病例疼痛明显缓解。治疗后24、48h视觉模拟评分(VAS)A组为3.68、3.54,B组为2.26、1.52,2组经比较,差异有显著性(P<0.05)。PCA按压次数和吗啡用量A组明显多于B组,B组生活总满意度明显高于A组。不良反应:恶心呕吐、便秘、嗜睡、皮肤瘙痒、尿潴留A组明显高于B组;呼吸抑制、幻觉发生率两组无差异。结论:经硬膜外小剂量氯胺酮辅助吗啡自控镇痛具有镇痛作用强、不良反应小等优点,适合有效治疗中、重度晚期顽固性癌痛。Background and purpose： The pain is not only one of the main symptom of cancer but also the main factor impacting on quality of life for the cancer patients. So it is a challenge to alleviate moderate to severe pain in late-phase cancer patients and reduce the rate of side effects at the same time. This study was to observe the efficacy of analgesic effects of small dosage ketamine associated with morphine for patient control epidural analgesia （PCEA） for cancer patients. Methods： 56 advanced cancer patients with moderate to severe pain were divided into two groups randomly, the first group was treated with the morphine PCEA （group A） and the second group with small dosage ketamine associated with morphine PCEA （group B）. The VAS （visual analogue scale） was used to evaluate the pain level, the side effects of the two groups were also analyzed. Results： Pain in the two groups were essentially alleviated, the VAS at observation time points were statistically different between the two groups （P〈0.05）, the PCEA pressing times and morphine dosage in group A was significantly more than that in group B. The satisfactory rate in group B was higher than the group A patients. The incidence of nausea, drowsiness, skin itch and urine retention in group A was higher than those in group B; the incidence of respiration depression and hallucination were not different between two groups. Conclusion： Small dosage ketamine associated with morphine patient control epidural analgesia （PCEA） approach appears to provide a safe and effective method for advanced cancer patients with moderate to severe pain.

关 键 词：吗啡 氯胺酮 镇痛 患者控制 癌痛 

分 类 号：R730.6[医药卫生—肿瘤]