右美托咪定联合静脉自控镇痛对阿片类药物耐受-口服困难癌痛患者的疗效分析  

On the therapeutic effect of dexmedetomidine combined with PCIA on opioid tolerant or difficult-in-oral-administration patients with cancer pain

作　　者：盛莉[1] 康延海[2] 陈邓林[1] 王琳[1] 黄丹丹[1] SHENG Li;KANG Yanhai;CHEN Denglin;WANG Lin;HUANG Dandan(First Department of Oncology,Hainan Provincial People’s Hospital/Hainan Hospital Affiliated to Hainan Medical College,Haikou 570311,China;Department of Psychology,Hainan Provincial People’s Hospital/Hainan Hospital Affiliated to Hainan Medical College,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院肿瘤内一科,海口570311 [2]海南省人民医院/海南医学院附属海南医院心理科,海口570311

出　　处：《长春中医药大学学报》2021年第2期330-333,共4页Journal of Changchun University of Chinese Medicine

基　　金：海南省科技项目资助(ZDYF2019189)。

摘　　要：目的探讨右美托咪定联合静脉自控镇痛(PCIA)对阿片类药物耐受-口服困难癌痛患者的治疗效果。方法选择120例阿片类药物耐受-口服困难癌痛患者作为研究对象,按照随机数字表法分为观察组与对照组,各60例。对照组予盐酸吗啡注射液进行治疗,观察组在对照组治疗基础上予盐酸右美托咪定注射液进行治疗,2组均在原用药基础上联合PCIA,均持续PCIA 1个月。比较2组PCIA 1个月后的镇痛疗效;对比2组PCIA前、PCIA 3 d、PCIA 1个月后的数字评分法(NRS)评分、Ramsa评分及生活质量;统计2组PCIA治疗期间的不良反应发生率。结果PCIA 1个月后,观察组总缓解率(91.67%,55/60)高于对照组(76.67%,46/60)(P<0.05)。与PCIA前比较,PCIA 3 d、1个月后,2组NRS评分均降低,且观察组低于对照组(P<0.05);2组Ramsa评分、生活质量评分均升高,且观察组均高于对照组(P<0.05)。PCIA期间,观察组不良反应发生率(10.00%,6/60)低于对照组(28.33%,17/60)(P<0.05)。结论右美托咪定联合PCIA可明显减轻阿片类药物耐受-口服困难癌痛患者疼痛程度,可改善患者镇静情况,有助于提高镇痛疗效,且具有较高安全性。Objective To investigate the therapeutic effect of dexmedetomidine combined with PCIA on opioid resistant or difficultin-oral-administration patients with cancer pain.Methods A total of 120 opioid resistant or difficult-in-oral-administration patients with cancer pain were selected as the research subjects.They were divided into observation group and control group by random number table method,with 60 cases in each group.The control group was treated with morphine hydrochloride injection,and the observation group was treated with dexmedetomidine hydrochloride injection on the basis of the treatment of the control group.Both groups were combined with PCIA on the basis of the original medication for 1 month.The analgesic effect of PCIA in two groups was compared after 1 month,and the numerical scoring(NRS)scores,Ramsa scores and quality of life of the 2 groups before PCIA,3 days after PCIA,and 1 month after PCIA were compared as well,and the incidence of adverse reactions during the treatment of PCIA in the two groups was statistically analyzed.Results One month after the PCIA treatment,the total remission rate of the observation group(91.67%,55/60)was significantly higher than that of the control group(76.67%,46/60)(P<0.05).After given the PCIA treatment for 3 days and 1 month,the NRS scores of the two groups both decreased,and the observation group was significantly lower than the control group(P<0.05),while the Ramsa score and quality of life score increased in both two groups,and the observation group were significantly higher than the control group(P<0.05).During the PCIA treatment,the incidence of adverse reactions in the observation group(10.00%,6/60)was significantly lower than that in the control group(28.33%,17/60)(P<0.05).Conclusion Dexmedetomidine combined with PCIA can significantly reduce the pain degree of cancer pain patients with opioid resistance or difficulty-in-oral-administration,improve the sedation of patients,and contribute to the improvement of analgesic efficacy,with higher safety.

关 键 词：癌痛 静脉自控镇痛 右美托咪定 吗啡 

分 类 号：R73[医药卫生—肿瘤]