鞘内注射吗啡治疗直肠癌重度癌性疼痛的疗效分析  

Effect of intrathecal injection of morphine on patients with severe rectum cancer pain

作　　者：董克军[1] 隋世华[2] 赵涛[1] 赵治涛[3] 法志强[4] 

机构地区：[1]日照市人民医院麻醉科,276826 [2]日照市人民医院神经内科,276826 [3]山东省交通医院疼痛科,济南250000 [4]国家临床重点专科,教育部工程技术研究中心,广东省脑功能修复与再生重点实验室,南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2016年第8期835-838,共4页Chinese Journal of Neuromedicine

基　　金：（1）基金项目：国家自然科学基金（31300921）（2）基金项目：广东省自然科学基金（S2013040016710）

摘　　要：目的评价鞘内注射吗啡治疗直肠癌重度癌性疼痛的疗效。方法选取日照市人民医院麻醉科自2014年4月至2015年4月收治的直肠癌重度癌性疼痛患者28例，在患者及家属知情同意的情况下分为鞘内注射吗啡组与硬膜外注射吗啡组，分别采用鞘内、硬膜外注射吗啡镇痛。鞘内注射吗啡组患者起始量为日平均用量的1/300，硬膜外注射吗啡组患者起始量为日平均用量的1/30，追加剂量均为起始剂量的1/10，锁定时间30 min。于镇痛前1 d及镇痛后1周、2周、4周观察患者静息状态和运动状态下视觉模拟评分（VAS）、QLQ-C30生活质量评分、每日吗啡用量和并发症的发生。结果与镇痛前1 d比较，2组患者在镇痛后1周、2周、4周的静息状态和运动状态VAS评分降低，QLQ-C30生活质量评分增加，每日吗啡用量降低，差异均有统计学意义（P〈0.05）；与鞘内注射吗啡组比较，硬膜外注射吗啡组患者在镇痛后1周、2周、4周的静息状态和运动状态VAS评分较高，QLQ-C30生活质量评分较低，每日吗啡用量较高，差异均有统计学意义（P〈0.05）。鞘内注射吗啡组患者并发症的发生率（21.4%）低于硬膜外注射吗啡组（71.4%），差异有统计学意义（P〈 0.05）。结论与硬膜外注射吗啡比较，鞘内注射吗啡治疗直肠癌重度癌性疼痛的效果更好。Objective To investigate the effect of intrathecal injection of morphine on patients with severe rectum cancer pain. Methods According to random number table method, 28 patients with severe rectum cancer pain, admitted to our hospital from April 2014 to April 2015, were divided into two groups： intrathecal injection of morphine group （group I） and epidural injection of morphine group （group E, n=l 4）. Patients in group I were treated with intrathecal injection of morphine, and group E with epidural injection of morphine; initial dose of group I was 1/300 of daily average dosage, and group E 1/30 of daily average dosage; the additional dose of two groups was 1/10 of initial dose, with a locked time of 30 min. Resting and moving visual analogue scale （VAS） scores, life scores of quality of life questionnaire （QLQ）-C30, and daily dose of morphine were observed on the day before analgesia （TO）,first week after analgesia （T1）, second week after analgesia （T2）, and first month after analgesia （T3）. Nausea and vomiting, skin itching, retention of urine, and headache were recorded at the four points. Results As compared with those at TO, the resting and moving VAS scores and daily dose of morphine were significantly lower, life scores of QLQ-C30 at the T1, T2 and T3 were significantly higher in both two groups （P〈0.05）. As compared with those in group I, the resting and moving VAS scores and daily dose of morphine in group E were significantly higher, life scores of QLQ-C30 in group E were significantly lower at the T1, T2 and T3 （P〈0.05）. The incidence of complications in group I （21.4%） was significantly lower than that in group E （71.4%）. Conclusion The effect of analgesia with intrathecal injection of morphine is better than that of analgesia of epidural injection of morphine in the treatment of severe rectum cancer pain.

关 键 词：重度癌性疼痛 鞘内注射 吗啡 视觉模拟评分 QLQ-C30生活质量评分 

分 类 号：R614[医药卫生—麻醉学] R735.37[医药卫生—外科学]