盐酸多沙普仑减轻晚期癌症疼痛患者自控静脉镇痛期嗜睡的效果  

Doxapram attenuates somnolence caused by intravenous analgesia in patients with refractory cancer pain

作　　者：袁孝忠[1,2] 周大春[1] 梁敏[1] 黄兵 

机构地区：[1]浙江大学医学院附属邵逸夫医院麻醉科,杭州310016 [2]浙江省嘉兴市第一医院麻醉科

出　　处：《上海医学》2011年第6期435-437,共3页Shanghai Medical Journal

摘　　要：目的观察盐酸多沙普仑对晚期癌症疼痛患者应用芬太尼+氯胺酮+咪达唑仑行患者自控静脉镇痛(PCIA)期嗜睡和镇痛的影响。方法 20例需要接受PCIA治疗的晚期癌症疼痛患者,均先后给予两种不同配方的镇痛药液进行自身对照。C配方为芬太尼+氯胺酮+咪达唑仑,D配方为C配方+盐酸多沙普仑。随机选择其中10例患者首次应用C配方,48 h后改用D配方;另外10例患者首次应用D配方,48 h后改用C配方。观察所有患者应用不同配方时期的镇痛镇静程度、生活质量评分(QOL评分)、血气分析结果及不良反应。结果所有患者在两种用药方案时期均获得较满意的镇痛效果,两种配方在各时间点的疼痛视觉模拟(VAS)评分的差异均无统计学意义(P值均>0.05)。用药后2、12、24 h,D配方的Ramsay评分均显著低于C配方(P值均<0.05),而QOL评分则显著高于C配方(P值分别<0.05、0.01)。D配方的pH值、动脉血氧分压、剩余碱均显著高于C配方(P值均<0.05),动脉血二氧化碳分压则显著低于C配方(P<0.01)。D配方镇痛期嗜睡、呼吸抑制的发生率均显著低于C配方(P值均<0.05)。结论晚期癌症疼痛患者PCIA配方中加入盐酸多沙普仑可改善患者的清醒程度,降低呼吸抑制发生率,提高患者的生活质量。Objective To observe the effect of doxapram on attenuating the degree of somnolence caused by fentanyl ＋ ketamine ＋ midazolam patient controlled intravenous analgesia（PCIA） in patients with refractory cancer pain.Methods Twenty patients with refractory cancer pain were randomly assigned to begin PCIA with two different formulas： one was fentanyl 2.0 mg＋ketamine 200 mg＋midazolam 10 mg in 200 mL pack（formula C）,and the other was also given doxapram 200 mg（formula D）.After the first dose was finished,the patients were switched to use the other formula.The analgesia effect,degree of sedation,quality of life（QOL） scores,blood gas and side-effects were compared between different formulas.Results The analgesic effects were satisfactory in all patients,and the visual analogue scale（VAS） scores were not significantly different with the treatments of either formula（P0.05）.Five patients had somnolence and 1 had respiratory depression during the treatment with formula D,and the numbers were 13 and 6 when they were treated with formula C,respectively（P0.05）.QOL score was significantly higher when patients were treated with formula D（39.35±8.79） compared with that in patients treated with formula C（31.45±9.42,P0.01） 2 h after PCIA.The Ph value,pressure of arterial oxygen（paO2）,and base excess（BE） with formula D were significantly higher than those with formula C（P0.05）,and the pressure of arterial carbon dioxide（paCO2） was significantly lower than that with formula C（37.48±2.52 vs.42.51±3.72,P0.01）.The incidences of hypersomnia and respiratory inhibition with formula D were significantly lower than those with formular C（P0.05）.Conclusion Addition of Doxapram for PCIA can effectively attenuate somnolence during intravenous analgesia for refractory cancer pain,and can improve the patients＇ quality of life.

关 键 词：多沙普仑 癌痛 静脉镇痛 不良反应 

分 类 号：R614[医药卫生—麻醉学]