自控式镇痛泵持续鞘内吗啡输注用于肺癌骨转移性癌痛的疗效观察  

Observation of efficacy on self-controlled intrathecal morphine delivery system in patients with bone metastasis cancer pain of lung cancer

作　　者：潘娟 汪桂青 Pan Juan;Wang Guiqing(Palliative Care Ward,The Affiliated Zhengzhou Central Hospital of Zhengzhou University)

机构地区：[1]郑州大学附属郑州中心医院康欣舒缓病区,郑州450000

出　　处：《重庆医科大学学报》2021年第1期107-110,共4页Journal of Chongqing Medical University

摘　　要：目的 :自控式镇痛泵(patient controlled analgesia,PCA)联合持续鞘内药物输注系统(intrathecal drug delivery system,IDDS)用于肺癌骨转移性癌痛(bone metastasis cancer pain of lung cancer)的镇痛疗效观察。方法:选择2017年11月至2018年11月就诊于郑州中心医院康欣舒缓病区的肺癌骨转移性癌痛患者为研究对象。根据入组标准从中选择30例,随机数字表法分为2组。观察组:植入IDDS,并外接PCA,持续吗啡注射液泵注,泵注速度(m L/h)=日初始剂量(mg)/(浓度·24),不低于0.1 m L/h。对照组:口服吗啡缓释片为主,吗啡注射液皮下应用处理暴发痛。在所有患者入组后规范化镇痛治疗前(T1)、治疗后3 d(T2)及治疗后1周(T3),分别记录其数字评分法(numerical rating scale,NRS)得分和吗啡日用量,测定患者唾液α-淀粉酶(salivaryα-amylase,SAA)活性。同时观察2种镇痛方式的不良反应。结果:通过重复测量分析,2组病例的NRS、SAA活性均随治疗的进行而逐渐下降,观察组的吗啡日用量随治疗的进行而逐渐下降;且所有指标在相邻时间点的下降差异有统计学意义(P<0.05);不同治疗方式之间有统计学差异(P<0.05)。鞘内持续用药不良反应少(P<0.01)。结论:与口服吗啡相比,IDDS联合PCA吗啡泵注可使肺癌骨转移性癌痛更快速、更大程度地缓解,显著改善患者焦虑和应激状态,且吗啡用量小,不良反应少。Objective:To investigate the feasibility of using patient controlled analgesia(PCA)combined with intrathecal drug delivery system(IDDS)in patients with bone metastasis cancer pain.Methods:From November 2017 to November 2018,patients with bone metastasis cancer pain in our department were included.Thirty patients were selected in accordance with inclusive criteria and randomly divided into two groups according to random digits table.Observation group:IDDS was implanted and PCA was externally connected;morphine was continuously injected,with speed(m L/h)=daily initial dose(mg)/(concentration*24),not lower than 0.1 m L/h.Control group:oral morphine sustained release tablets were mainly used and morphine injection was subcutaneously injected to control breakthrough pain.The numerical rating scale(NRS)score,the daily morphine dose and the salivaryα-amylase(SAA)activity were recorded before treatment(T1),three days after treatment(T2),and one week after treatment(T3)were recorded,and adverse reaction of two kinds of analgesia were observed.Results:According to repeated measurement,NRS and SAA activity were gradually decreased with the progress of treatment,and daily morphine dosage in the observation group was gradually decreased,with significant difference between the two adjacent time points(P<0.05),and with significant difference between different treatment methods(P<0.05).Usage of intrathecal sustained medication had fewer adverse reactions(P<0.01).Conclusion:Compared with oral morphine,IDDS combined with PCA can make bone metastasis cancer pain alleviate more rapidly to a greater extent,which can significantly improve patients’anxiety and stress.In addition,the dosage of morphine is small and the adverse reaction is less.

关 键 词：鞘内药物输注系统 自控式镇痛泵 肺癌骨转移性癌痛 唾液α-淀粉酶 

分 类 号：R730.6[医药卫生—肿瘤]