罗哌卡因对氢吗啡酮鞘内自控镇痛治疗难治性上腹部癌痛患者疗效的影响  

Effects of ropivacaine on patient-controlled intrathecal analgesia with hydromorphone in the treatment of patients with refractory upper abdominal cancer pain

作　　者：陈付强[1] 封明霞 于洋[1] 孙明洁[1] 孟静[1] 王伟宁 Chen Fuqiang;Feng Mingxia;Yu Yang;Sun Mingjie;Meng Jing;Wang Weining(Department of Pain Medicine,East Branch of Qingdao Municipal Hospital,Qingdao City 266071,China;Department of Anesthesiology,the Fifth People's Hospital of Qingdao,Qingdao City 266002,China;Department of Pain Medicine,Shanxian Central Hospital,Heze City,Shandong Province 274300,China)

机构地区：[1]青岛市市立医院东院区疼痛科,266071 [2]青岛市第五人民医院麻醉科,266002 [3]单县中心医院疼痛科,山东省菏泽市单县274300

出　　处：《中华疼痛学杂志》2020年第2期112-118,共7页Chinese Journal Of Painology

摘　　要：目的观察罗哌卡因对氢吗啡酮鞘内输注自控镇痛治疗上腹部难治性癌痛疗效的影响。方法收集2017年3月至2019年3月青岛市市立医院疼痛科收治的上腹部难治性癌痛患者60例,采用随机数字法将其随机分成两组,每组30例,所有患者均行鞘内输注港植入术。A组为氢吗啡酮输注组,B组为罗哌卡因联合氢吗啡酮输注组。前者药物为氢吗啡酮20 mg,后者为氢吗啡酮20 mg+1%罗哌卡因20 ml,两组均溶入0.9%氯化钠注射液至200 ml。记录两组患者鞘内镇痛治疗前(T0)及治疗后1 d(T1)、1周(T2)、1个月(T3)时视觉模拟评分(VAS)、SF-36健康调查简表(SF-36)生活质量评分、阿片药物用量及不良反应。测定T0、T3时CD3^+、CD4^+、CD4^+/CD8^+及NK细胞活性。结果与T0时比较,鞘内自控镇痛后各时点VAS评分、SF-36生活质量各分项评分均改善(P均<0.05);与T0时比较,两组患者T3时的CD3^+、CD4^+、CD4^+/CD8^+及NK细胞活性较高(P均<0.05);与A组比较,B组T3时VAS评分较低(P均<0.05);两组间各时点SF-36生活质量各分项评分、淋巴细胞亚群及不良反应比较,差异均无统计学意义(P均>0.05);与A组比较,B组患者T2、T3时氢吗啡酮用量均较少[(0.82±0.18)比(2.12±0.12)mg,(1.52±0.26)比(4.35±0.42)mg,P均<0.05]。结论罗哌卡因联合氢吗啡酮较单独氢吗啡酮鞘内输注治疗难治性上腹部癌痛,短期镇痛及对生活质量和免疫状态影响相当,但长期镇痛较优,且可减少氢吗啡酮用量。Objective To observe the effects of ropivacaine on patient self-controlled intrathecal analgesia with hydromorphone for patients with refractory upper abdominal cancer pain.Methods Sixty patients with refractory upper abdominal cancer pain in Department of Pain Medicine,Qingdao Municipal Hospital,from March 2017 to March 2019,were randomly divided into two groups,hydromorphone group(group A)and ropivacaine combined with hydromorphone group(group B),30 patients in each group.Intrathecal infusion port was implanted in all patients.Patients were received hydromorphone 20 mg diluted to 200 ml with normal saline in group A,while hydromorphone 20 mg combined with 1%ropivacaine 20 ml diluted to 200 ml in group B.Visual analogue scale(VAS),SF-36 health survey brief form(SF-36)quality of life score,opioid dosage and the incidence of adverse reaction were observed before the infusion(T0)and 1 day(T1),1 week(T2),1 month(T3)after the infusion in the two groups.Results Compare with T0,VAS,SF-36 scores,opioid dosage and the incidence of adverse reaction were improved at each time point after the infusion in the two groups(all P<0.05).The activity of CD3^+,CD4^+,CD4^+/CD8^+and NK cells were higher at T3 than that at T0(P<0.05).Compared with group A,VAS was low in group B at T3(P<0.05).There were no differences in SF-36 scores,the activity of T lymphocyte subsets and adverse reaction at each time point in two groups(all P>0.05).The dosage of hydromorphone was less in group B than that in group A at T2 and T3 respectively[(0.82±0.18)vs.(2.12±0.12)mg,(1.52±0.26)vs.(4.35±0.42)mg,all P<0.05].Conclusion The analgesic effects of ropivacaine combined with hydromorphone is similar to that of hydromorphone alone in intrathecal analgesia in the treatment of patients with refractory upper abdominal cancer pain,but the long-term analgesic effect is better and the dosage of hydromorphone is reduced.

关 键 词：罗哌卡因 氢吗啡酮 注射 脊髓 疼痛 顽固性 肿瘤 

分 类 号：R730[医药卫生—肿瘤]