硬膜外注射与鞘内注射吗啡治疗老年晚期癌症重度癌性疼痛的临床疗效及对生活质量评分的影响  

The comparison of clinical efficacy and quality of life score of morphine epidural or intrathecal injection in the treatment of severe cancer pain in elderly patients with terminal cancer

作　　者：余慧青[1] 冯道春[2] 田玲[1] 杨列军[1] 梁冠中[1] 刘师宏[1] 

机构地区：[1]重庆市肿瘤研究所,重庆400030 [2]遵义市第一人民医院

出　　处：《中国老年学杂志》2017年第24期6122-6125,共4页Chinese Journal of Gerontology

基　　金：重庆市卫生和计生委科研基金资助(2017jstg07)

摘　　要：目的研究老年晚期癌症重度癌性疼痛治疗中硬膜外注射与鞘内注射吗啡对临床疗效及生活质量评分的影响。方法选取晚期癌症重度癌性疼痛患者48例,根据患者意愿分为硬膜外组(n=27)和鞘内注射组(n=21)。硬膜外组采用硬膜外注射吗啡镇痛治疗,鞘内注射组采用鞘内注射吗啡镇痛治疗。对比两组患者镇痛前后每日吗啡的平均用量、生活质量评分(QLQ-C30)、疼痛评估视觉模拟评分(VAS)、细胞免疫功能和安全性。结果硬膜外组患者每日吗啡用量于镇痛后1 w、2 w及1个月时较鞘内注射组高(P<0.05),且两组患者镇痛后各时点的每日吗啡平均用量均较各自镇痛前低(P<0.05)。硬膜外组患者QLQ-C30评分于镇痛后1 w、2 w及1个月时较鞘内注射组低(P<0.05),且两组患者镇痛后各时点的QLQ-C30评分均较各自镇痛前高(P<0.05)。硬膜外组患者运动及静息状态下VAS于镇痛后1 w、2 w及1个月时较鞘内注射组高(P<0.05),且两组患者镇痛后各时点的运动及静息状态下VAS均较各自镇痛前低(P<0.05)。鞘内注射组患者镇痛后1个月CD3^+、CD4^+、CD4^+/CD8^+水平较硬膜外组均明显升高(P<0.05)。镇痛后1个月CD8^+水平两组对比无显著差异(P>0.05),且两组患者镇痛后1 w、1个月的CD3^+、CD4^+水平与镇痛前对比均有统计学差异,而两组患者镇痛后1 w的CD8^+、CD4^+/CD8^+水平与镇痛前对比无显著差异(P>0.05),镇痛后1个月与镇痛前对比有显著差异(P<0.05)。两组患者均有并发症发生,硬膜外组并发症发生率为59.26%明显高于鞘内注射组19.05%(P<0.05)。结论对于晚期癌症重度癌性疼痛患者的疼痛可通过单纯持续鞘内注射吗啡有效缓解,鞘内应用吗啡用量更小。Objective To study the comparison of clinical efficacy and quality of life score of morphine epidural or intrathecal injection in the treatment of severe cancer pain in elderly patients with terminal cancer. Methods 48 severe pain in elderly patients with terminal cancer were divided into epidural（ n = 27） and intrathecal（ n = 21） groups. The patients of epidural group were treated by epidural morphine injection,while ones of intrathecal group were treated by intrathecal morphine injection. The average daily dose of morphine,QLQ-C30 score,VAS score,cellular immune function and safety were compared. Results The average daily dose of morphine after analgesia 1,2 weeks and 1 month of epidural group were much higher than those of intrathecal group（ P〈0. 05）,which were all much lower in two groups than those of pre-analgesia respectively（ P〈0. 05）. The QLQ-C30 score and VAS after analgesia 1,2 weeks and 1 month after analgesia of epidural group were much lower than those of intrathecal group（ P〈0. 05）,which were all much higher in two groups than those of pre-analgesia respectively（ P〈0. 05）. The CD3～＋、CD4～＋、CD4～＋/CD8～＋levels after analgesia 1 month of intrathecal group were much higher than those of epidural group（ P〈0. 05）,the CD8～＋ level of 1 month after analgesia of two groups had no statistical difference（ P〈0. 05）,and the CD3～＋,CD4～＋ levels of 1 week and 1 month after analgesia of two groups had statistical differences with pre-analgesia,while the CD8～＋、CD4～＋/CD8～＋ levels of 1 week after analgesia had no statistical differences with pre-analgesia（ P〈0. 05）,and CD8～＋、CD4～＋/CD8～＋ levels of 1 month after analgesia had statistical difference with pre-analgesia（ P〈0. 05）. The complication rate of epidural group was 59. 26%,which was lower than that of intrathecal group 19. 05%（ P〈0. 05）. Conclusions For patients with advanced cancer and severe cancer pain,the pain could be relieved by means of sim

关 键 词：晚期癌症 癌性疼痛 硬膜外 鞘内 生活质量 免疫功能 

分 类 号：R73[医药卫生—肿瘤]