吗啡复合不同浓度右美托咪定鞘内泵注对恶性肿瘤晚期患者镇痛的疗效  

Effects of different doses of intrathecal dexmedetomidine combined with morphine analgesia in patients with advanced malignant tumor

作　　者：张怀奇 李贺[1] 刘纪文[1] 韩卫东[1] 任从才 钱自亮 

机构地区：[1]中山大学附属第八医院疼痛科,深圳518000 [2]中山大学附属第八医院麻醉科,深圳518000 [3]深圳市福田区妇幼保健院,518000

出　　处：《实用疼痛学杂志》2017年第6期425-430,共6页Pain Clinic Journal

摘　　要：目的探讨吗啡复合不同浓度右美托咪定鞘内连续注射对恶性肿瘤晚期患者镇痛的疗效。方法癌痛患者80例均接受椎管内镇痛药输注港皮下植入术，并随机分为鞘内泵入吗啡组（A组）、鞘内泵人吗啡复合右美托咪定1．0μg／ml组（B组）、复合右美托咪定1．5μg／ml组（C组）及复合右美托咪定2．0μg／ml组（D组），每组20例。记录4组患者疼痛评分、满意度、吗啡剂量及生活质量评分，并观察获得满意镇痛后的不良反应。结果与A组比较，B、C、D组鞘内植入泵后6、12、24、48、72h时VAS评分降低（P〈0．05），B、C、D组比较差异无统计学意义（P〉0．05）；与A组和B组比较，C、D组鞘内植入泵后6、12、24、48、72h时Ramsay评分明显升高（P〈0．05），C组与D组比较，差异无统计学意义；与A组和B组比较，C、D组患者生活质量各项评分及总分升高（P〈0．05），C组与D组比较，差异无统计学意义。4组患者对鞘内置入泵的总体满意度C组〉B组〉D组〉A组，其中C组满意度最高。B、C、D组72h内吗啡总量较A组明显降低（P〈0．05），C、D组的吗啡总量较B组明显减少（P〈0．05）。鞘内给予右美托咪定后便秘、恶心、呕吐等发生率显著减少。但D组患者嗜睡、低血压、心动过缓发生率显著增加。其余不良反应发生率差异无统计学意义。所有患者均未见呼吸抑制和高血压等严重不良反应。结论鞘内连续注射右美托咪定1．5μg／ml可加强癌痛患者鞘内吗啡的镇痛作用，减少吗啡用量，提高患者生活质量及满意度，并无严重不良反应发牛。Objective To study the effects of different doses of intrathecal dexmedetomidine （Dex） combined with morphine analgesia in the treatment of patients with advanced malignant tumor. Methods Eighty patients with advanced malignant tumor were randomly divided into 4 groups, 20 cases in each group. All patients were intrathecally implanted with permanent analgesic pump. The patients received intrathecal injection of morphine in group A, 1.0 μg/ml Dex combined with morphine in group B, 1.5 μg/ml Dex combined with morphine in group C, and 2.0 μg/ml Dex combined with morphine in group D. VAS, satisfaction level, morphine doses, quality of life score and adverse reactions were observed and compared. Results VAS was lower in group B, C, D than that in group A at 6, 12, 24, 48, 72 h after implantation of analgesic pump （P〈 0.05）, but no significant difference among group B, C and D. Ramsay score was higher in group C and D than that in group A and B at 6, 12, 24, 48, 72 h after implantation of analgesic pump （P〈0.05）, but no significant difference between group C and D. The quality of life score was higher in group C and D than that in group A （P〈0.05）, but no significant difference between group C and D. The satisfaction level was highest in group C. The total amount of morphine within 72 h was significantly lower in group B, C and D than that in group A （P〈 0.05）, and significantly lower in group C and D than that in group B, but no significant difference between group C and D. The incidence of constipation, vomiting and nausea decreased significantly after intrathecal administration of Dex, but the incidence of lethargy, hypotension and bradycardia increased significantly in group D, but no significant difference in the incidence of other adverse reactions. Conclusions Continuously intrathecal injection of 1.5 μg/ml dexmedetomidine combined with morphine can effectively reduce the dosage of morphine, enhance morphine analgesic effect, patient＇s satisfaction and quality of life in patient

关 键 词：右美托咪啶 吗啡 鞘内注射 癌痛 

分 类 号：R730.5[医药卫生—肿瘤]