晚期癌症患者硬膜外自控镇痛(PECA)疗效观察  

The Effect of Patient Epidural Controlled Analgesia in Late-stage Cancer Patients

作　　者：李越[1] 马长青[1] 

机构地区：[1]天津医科大学附属肿瘤医院麻醉科,天津市300060

出　　处：《中国肿瘤临床》1999年第12期902-904,共3页Chinese Journal of Clinical Oncology

摘　　要：目的 :为更好地治疗晚期癌痛患者 ,特别是剧烈的顽固性疼痛。方法 :我们引进和采用了硬膜外自控镇痛的方法PatientEpiduralControlledAnalgesia(PECA)。观察了 2 2例疼痛较剧烈的患者 ,其虽经不同途径 (口服、皮下及静脉 )使用大剂量阿片类药物 ,但未能很好地控制疼痛 ,同时毒副作用较大。对此采用PCA方法用于以上患者的除痛 ,在减少阿片类药物用量的同时使除痛效果明显提高。注射液浓度依病变部位及疼痛程度而定。一般为5 0ml 0 5 %～ 1%利多卡因药液中加入 5 0mg吗啡、氟哌啶 5～ 10mg。同时 ,应严格锁定每次注液量及间隔时间。治疗效果由患者采用 0～ 10疼痛自测分级表自行划定。结果 :经治疗疼痛全部缓解。同时因减少了阿片类药物的用量 ,毒副作用明显减轻。本次观察平均带管时间为 5 5± 12天 ,无 1例发生硬膜外感染。结论 :本方法在癌性疼痛治疗中的主要优点是有效、方便、安全 ,特别适用于家庭病床癌痛患者的除痛治疗。主要的并发症有腹胀、硬膜外感染等 ,只要密切观察 ,随时调整药物浓度即可防止并发症发生。Aim: To evaluate the effect of patient epidural controlled analgesia (PECA) in late-stage cancer patients Methods: The severe pain of 22 advanced cancer patients who failed in the treatment of large dose of opium were treated with PECA to relief the pain Morphine 50mg, Haloperidol 5～10mg added into 0 5～1%Lidocaine 50ml was given in a strictly controlled dose and interval time, and the effect was assessed by the 0～10 Numeric Pain Intensity Scale Results: By this method, all the patients′pain were relieved in a reduced opium dosage with very mild toxicity and side effect, and no epidural complications observed Conclusion: PECA is effective in the treatment of pain in advanced cancer patients It is safe and easy to control and can be used easily in the home patients of late stage cancer The complications of abdominal distention and epidural infection can be prevented by intensive care and appropriate concentration of the drug

关 键 词：癌痛 治疗 硬膜外自控镇痛 吗啡 利多卡因 

分 类 号：R730.5[医药卫生—肿瘤]