布比卡因联合吗啡连续蛛网膜下隙注入用于晚期癌性疼痛临床观察  

Continuous subarachnoid injection with bupivacaine and morphine for analgesia in advanced cancer

作　　者：庾俊雄[1] 刘辉梅[1] 葛波[1] 丁可[1] 文向萍[1] 

机构地区：[1]桂林医学院附属医院,广西桂林541001

出　　处：《山东医药》2013年第31期7-9,共3页Shandong Medical Journal

基　　金：广西科学自然基金项目(桂科自0728231);广西壮族自治区卫生厅自筹经费科研课题项目(Z2009040)

摘　　要：目的探讨连续蛛网膜下隙注药用于晚期癌痛患者的镇痛疗效。方法将32例晚期癌痛患者随机分为观察组与对照组各16例,观察组采用布比卡因联合吗啡连续蛛网膜下隙镇痛,对照组采用布比卡因联合吗啡硬膜外镇痛,测定镇痛前、镇痛后1、4周的T细胞免疫功能指标的变化。分别观察镇痛前、镇痛后24 h、72 h、1周的VAS评分,吗啡的用量,不良反应发生情况。结果镇痛后4周观察组与对照组CD+3水平分别为58.37±4.16、54.51±2.55,CD+4水平分别为35.76±2.97、30.03±2.33,CD+4/CD+8分别为1.47±0.15、1.35±0.13,两组比较,P<0.05;VAS评分分别为(2.00±0.89)、(2.12±0.96)分,两组比较,P<0.05;吗啡用量分别为(9.38±2.44)、(64.79±13.47)mg,两组比较,P<0.01。观察组与对照组恶心呕吐发生率分别为25%、62.5%,呼吸抑制发生率为0、12.5%,皮肤瘙痒发生率为18.75%、50%,两组比较,P均<0.05。结论连续蛛网膜下隙注药用于晚期癌性疼痛患者可明显减轻患者疼痛,改善患者免疫功能,且不良反应发生率低。Objective To investigate the therapeutic effect of continuous subarachnoid injection with bupivacaine and morphine on analgesia in advanced cancer. Methods Thirty-two patients with advanced cancer pain were randomly divided into 2 groups, 16 in each： the observation group and control group. In the observation group, continuous subarachnoid injection with bupivacaine and morphine was used for analgesia, while in the control group, epidural injection with bupiva- caine and morphine was used for analgesia. Changes of T cell immune function was measured before treatment, 1 week, 4 weeks after treatment. The VAS of pre-analgesia, after analgesia 24 h, 72 h and 1 week, adverse reactions, dosage of morphine were observed. Results After 4 weeks of treatment, the levels of CD3 in the observation group and control group were separately 58.37 ±4.16, 54.51 ± 2.55 ; the levels of CD4＋ were 35.76 ± 2.97, 30.03 ± 2.33 ; the ratio of CD4＋ CD8 was 1.47 ±0.15, 1.35 ± 0. 13, and the difference was significant （P 〈 0.05）; VAS scores in two groups were （2.00 ± 0.89） and （2.12 ± 0.96）, and the difference was significant （ P 〈 0.05 ） ; the dosage of morphine in the two groups were （9.38 ± 2.44） and （64.79 ± 13.47） mg, the difference was statistically significant （ P 〈 0.01 ）. In the observation and control groups, the incidence of nausea and vomiting was 25% and 62.5%, respiratory inhibition rates were 0% and 12.5%, occurrence rates of skin pruritus were 18.75% and 50% , respectively, and the difference was significant （P 〈0.05 ）. Conclusion The continuous subarachnoid injection with bupivacaine and morphine on analgesia in advanced cancer can significantly alleviate the pain of patients, improve the immune function, and reduce the incidence of adverse reactions.

关 键 词：蛛网膜下隙 吗啡 癌痛 镇痛 免疫功能 

分 类 号：R441.1[医药卫生—诊断学]