经鞘内输注系统输注小剂量吗啡对顽固性晚期癌痛患者镇痛效果及细胞免疫功能的影响  

Therapeutic effect of the intrathecal drug delivery systems and the influence on immune function among patients with advanced cancer pain

作　　者：俞良[1] 邓芳[1] 李庆华[1] 丁卫华[1] 李秀秀[2] 孙建良[1] 

机构地区：[1]南京医科大学附属杭州医院(杭州市第一人民医院)麻醉和疼痛科,浙江杭州310006 [2]浙江大学医学院,浙江杭州310058

出　　处：《中国临床药理学与治疗学》2016年第8期926-930,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省卫生科技计划项目(2013KYB209,2014KYA174)

摘　　要：目的:探讨经鞘内输注系统输注小剂量吗啡对顽固性晚期癌痛患者镇痛效果及细胞免疫功能的影响。方法:选择2014年1月至2015年8月就诊于南京医科大学附属杭州医院的顽固性晚期癌痛患者32例,术前均口服吗啡镇痛,入院排除手术禁忌后均予以鞘内输注吗啡治疗,在达到疼痛缓解时视觉模拟评分(visual analogue scale,VAS)≦2维持给药至观察中止。观察32例治疗前与治疗后1周的VAS评分,药物毒副反应、吗啡的日消耗量以及T细胞、B细胞、NK细胞等免疫功能指标的变化,同时观察患者的生存期。结果:研究发现:(1)术后患者最长生存期为207 d,最短为22 d,平均生存期为(109.6±49.6)d。术后1周吗啡的日均消耗量(3.60±3.25)mg明显低于治疗前口服吗啡日均消耗量(397.50±304.66)mg,差异具有统计学意义(t=-7.388,P<0.01);(2)VAS评分较术前明显下降,差异有统计学意义(7.53±1.05 vs 1.72±0.77;t=22.729,P<0.001);(3)药物的毒副反应较前明显减少;(4)T细胞亚群CD_4^+、CD_4^+/CD_8^+、NK细胞等指标升高显著,T细胞亚群CD_8^+下降显著,与鞘内输注系统植入前比较差异均有统计学意义(均P<0.001)。结论:与口服阿片类相比,鞘内输注系统植入能更有效缓解晚期癌痛,减少吗啡的日消耗量,减少阿片类药物的毒副反应,并在一定程度上提高晚期癌痛患者的免疫功能。AIM： To evaluate the efficacy of intrathecal infusion small dose morphine in the treatment of patients with advanced cancer pain and its curative effects on immune function. METHODS：32 patients with advanced cancer pain admitted to Hang Zhou affiliated Hospital of Nanjing Medical University from January 2014 to August 2015 all took morphine orally to treat pain before operation. After excluding surgical contraindication in hospital all patients were infused morphine by intrathecal drug delivery system. A constant infusion rate and morphine dose was maintained at the level where pain was relieved and the visual analogue scale（ VAS） rated 2or below 2 and continued until the end of the observation period. The Visual analogue scale（ VAS）,side-effects of drug,average daily consumption of morphine and changes in immune functions including T cells,B cells,NK cells were observed before and 1 week after the operation. The survival time of the patients were observed. RESULTS：（ 1） Postoperative patients with the longest survival period was207 days,the shortest survival period was 22 days,the average survival period was（ 109. 6 ± 49. 6）days. Average daily consumption of morphine was significantly lower than that of pre-operation（ 3. 60± 3. 25 mg vs 397. 50 ± 304. 66 mg） and the difference was statistically significant（ t =- 7. 388,P〈0. 01）.（ 2） VAS significantly decreased after operation compared to the level in the pre-operation period,and the difference was statistically significant（ 7. 53 ± 1. 05 vs 1. 72 ± 0. 77; t = 22. 729,P〈0. 001）.（ 3） The side-effect of morphine was significantly reduced compared to that during pre-operation.（ 4） T cell subset CD_4^＋,CD_4^＋/ CD_8^＋,NK cell elevated and T cell subset CD8＋ decreased in the observation 1-week later,and the difference was statistically significant（ P〈0. 001）. CONCLUSION：Intrathecal infusion small dose morphine for patients with advanced cancer pain achieves more effective pain relief,reduces morphine

关 键 词：鞘内输注系统 晚期癌痛 免疫功能 

分 类 号：R743.1[医药卫生—神经病学与精神病学]