鞘内泵入吗啡联合地塞米松治疗癌性骨痛的随机对照研究  

Randomized controlled clinical study on combination of morphine and dexamethasone through intrathecal pumping injection in patients with cancer-induced bone pain

作　　者：张先红[1,2] 黄东[3,4] 杨金凤[2] 杨弘彪 唐轶徇 刘景诗[2] 黄玉梅[5] 陈师[2] 王林纤[5] 彭海燕[2] 

机构地区：[1]中南大学湘雅医学院麻醉学系,湖南长沙410013 [2]湖南省肿瘤医院麻醉科疼痛病房,湖南长沙410013 [3]中南大学湘雅三医院麻醉科,湖南长沙410013 [4]中南大学疼痛医学研究所,湖南长沙410013 [5]湖南省肿瘤医院检验科,湖南长沙410013

出　　处：《肿瘤》2015年第4期439-445,共7页Tumor

基　　金：国家自然科学基金资助项目(编号:81172546);湖南省医药卫生科研计划课题项目(编号:B2014-106;C2014-35)~~

摘　　要：目的 :研究鞘内连续注射吗啡联合地塞米松治疗癌性骨痛(cancer-induced bone pain,CIBP)的疗效及其机制。方法:76例CIBP患者均接受椎管内镇痛药输注港皮下植入术,并随机分入吗啡组(A组38例,鞘内泵入吗啡)和吗啡联合地塞米松组(B组38例,鞘内泵入吗啡和地塞米松)。于治疗前以及治疗开始后第1、3、7天评定11点数字评分量表(11-Point Numeric Rating Scale,NRS-11)评分、每日爆发痛次数、生活质量和SF-36量表评分。治疗开始后第7天测定血浆内啡肽和胃动素以及脑脊液中前列腺素E2、P物质和降钙素基因相关肽的水平。结果:B组疼痛缓解效果明显,治疗开始后第1、3、7天的每日爆发痛次数均明显少于A组(P<0.05);2组治疗后的NRS-11评分均<2分,但2组之间NRS-11评分的差异无统计学意义;B组治疗开始后第3和7天的SF-36量表评分和生活质量均较A组有显著改善(P<0.05)。治疗开始后第7天,2组的血浆内啡肽水平差异无统计学意义(P>0.05),但B组的血浆胃动素水平高于A组(P<0.05);B组脑脊液中前列腺素E2、P物质和降钙素基因相关肽水平均低于A组(P<0.05)。结论:鞘内泵入吗啡联合地塞米松与鞘内泵入吗啡相比,可减少CIBP的爆发痛次数,改善患者的生活质量;并可升高血浆胃动素水平,降低脑脊液中前列腺素E2、P物质和降钙素基因相关肽的水平,减轻吗啡耐受,增强镇痛效果。Objective： To investigate the effcacy of patients with cancer-induced bone pain（CIBP） treated with morphine in combination with dexamethasone through intrathecal pumping injection and its mechanism.Methods： Seventy-six patients with CIBP undergoing implantation of an infusion port with intrathecal catheter were randomly dividedin to group A（n = 38, intrathecally injected with morphine alone and group B（n = 38, intrathecally injected with morphine in combination with dexamethasone）. The pain relief degree by 11-Point Numeric Rating Scale（NRS-11） score, the frequency of breakthrough pain, quality of life and SF-36 scale score were evaluated before treatment and the1 st, 3rd and 7th days after the beginning of intrathecal pumping. Ont he 7th day after treatment, the concentrations of β-endorphin（β-EP） and motilin in plasma as well as prostagland in E2（PGE2）, substance P（SP） and calcitonin gene-related peptide（CGRP） in cerebrospinal fluid（CSF） were determined.Results： The pain was relieved significanly in group B, and the frequencies of breakthrough pain per day were less than those in group A on the 1st, 3rd and 7th days after treatment（all P 〈 0.05）; the NRS-11 score was 〈 2 in two groups after treatment, but there was no significant difference between the two groups（P 〉 0.05）; in group B, the SF-36 scale score and quality of life were both improved significantly on the 3rd and 7th days after treatment as compared withth ose of group A（all P 〈 0.05）. On the 7th day after treatment, thee ndorphin level in plasma was not significantly different between the two groups（P 〉 0.05）,but the motilin level in plasma in group B was significantly higher than that in group A（P 〈 0.05）; the PGE2, SP and CGRP levels in CSF in group B were significantly lower than those in group A（all P 〈 0.05）.Conclusion： Intrathecal pumping injection of morphine in combination with dexamethasone can be of great help in decreasing the frequency of breakthrough of CI

关 键 词：癌性骨痛 鞘内泵入 吗啡 地塞米松 生活质量 

分 类 号：R735.2[医药卫生—肿瘤]