加巴喷丁联合蛛网膜下腔吗啡输注治疗晚期癌痛的临床研究  

CLINICAL RESEARCH OF GABAPENTIN COMBINED WITH MORPHINE BY SUBARACHNOID SPACE IMPLANTABLE PUMP IN THE TREATMENT OF ADVANCED CANCER PAIN

作　　者：邹聪[1] 何云武[1] 龙石银[1] 廖梦君[1] 龙慧[1] 李威[1] 

机构地区：[1]南华大学附属第二医院疼痛科,衡阳421001

出　　处：《中国疼痛医学杂志》2012年第10期618-622,627,共6页Chinese Journal of Pain Medicine

基　　金：湖南省卫生厅项目(B2011-055)

摘　　要：目的 :探讨加巴喷丁联合蛛网膜下腔植入式输注系统吗啡输注用于晚期癌痛的疗效,以及对患者的免疫功能的影响。方法 :晚期癌痛患者40例,A组为加巴喷丁联合蛛网膜下腔植入式输注系统吗啡输注(n=13例);B组为安慰剂联合蛛网膜下腔植入式输注系统吗啡输注(n=12例);对照C组为口服吗啡进行镇痛(n=15例)。在达到疼痛缓解时视觉模拟评分(visual analogue scale,VAS)≤2维持给药至观测终止。分别观察A、B、C三组治疗前与治疗后24 h、72 h、1周、1个月的VAS,睡眠质量,药物毒副反应的差异;比较至观测终止时吗啡的日消耗量;治疗前、观测终止时T细胞、NK细胞等免疫功能指标的变化。结果 :通过为期1个月的研究,分析3组治疗前后的相关指标发现:(1)评价疼痛控制程度及睡眠质量、药物的毒副反应、吗啡的日均消耗量,与B、C组相比,A组疗效最好,吗啡日消耗量最少。(2)与B、C组相比,A组T细胞亚群CD3+、CD4+、CD4+/CD8+、NK细胞表面标志物CD16+/CD56+等指标升高最为显著,并有统计学差异(P<0.05)。结论 :加巴喷丁联合蛛网膜下腔植入式输注系统吗啡输注能更有效的缓解疼痛,减少吗啡的消耗量,减少药物的毒副反应,同时能提高睡眠质量及机体的免疫功能。Objective： To evaluate the efficacy of gabapentin combined with infusion of morphine by subarachnoid space implantable pump in the treatment of advanced cancer pain and its curative effects on immune function.Methods： 40 patients with advanced cancer pain were divided into three groups： group A（n = 13） were treated by gabapentin combined with infusion of morphine by subarachnoid space implantable pump;group B（n = 12） were treated by placebo combined with infusion of morphine by subarachnoid space implantable pump;group C（n = 15） received treatment of oral morphine only.a constant infusion rate and morphine dose was maintained when pain was relieved.The Visual analogue scale（VAS）,quality of sleep（QS）,side-effects were observed before and 24 h,72 h,1 week,1 month after treatment and average daily consumption of morphine was recorded.changes in immune functions including T cells,NK cells were tested before and after the observation.Results：（1） According to the VAS scores,QS,side-effects,average daily consumption of morphine,group A had the best efficacy and the least average daily consumption of morphine than group B and C.（2） CD3＋,CD4＋,CD4＋/CD8＋ T cell subset,NK cell surface marker CD16＋/CD56＋ were elevated significantly in group A than group B and C（P 0.05）.Conclusion： Gabapentin combined with infusion of morphine by subarachnoid space implantable pump achieves more effective pain relief,reduces morphine consumption and adverse effects,and improves qualily of sleep and body＇s immune function.

关 键 词：加巴喷丁 吗啡 癌痛 蛛网膜下腔 输注泵 镇痛 

分 类 号：R730.5[医药卫生—肿瘤]