氢吗啡酮不同镇痛方式对难治性癌痛患者镇痛效果及睡眠质量的影响  

Effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain

作　　者：徐慧胜[1] 兰允平[1] 夏云 王建[1] 黄岗 赖凯丽 余功敏[1] Huisheng Xu;Yunping Lan;Yun Xia;Jian Wang;Gang Huang;Kaili Lai;Gongmin Yu(Department of Anesthesiology,Quzhou People's Hospital,Quzhou 324000,Zhejiang Province,China;Department of Anesthesiology,Quzhou Kecheng Maternal and Child Health Hospital,Quzhou 324000,Zhejiang Province,China)

机构地区：[1]衢州市人民医院麻醉科,衢州324000 [2]衢州市柯城区妇幼保健院麻醉科,衢州324000

出　　处：《中国基层医药》2023年第1期58-62,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省衢州市科技计划指导性项目(20172038)。

摘　　要：目的:研究氢吗啡酮不同镇痛方式对难治性癌痛患者的镇痛效果及睡眠质量的影响。方法:选取2017年8月至2019年12月在衢州市人民医院治疗的三阶梯镇痛方案效果不佳的顽固性癌痛患者60例,按照随机数字表法分为氢吗啡酮静脉自控镇痛组(HV组)和氢吗啡酮鞘内自控镇痛组(HI),每组30例。HV组静脉给予氢吗啡酮注射液,HI组鞘内给予氢吗啡酮注射液,两组均治疗10 d。分别于给药前、给药后2 h、4 h、24 h、48 h、10 d,采用数字分级评分(NRS)评估两组镇痛效果;记录两组患者各时间点爆发痛(BTP)的发生次数;采用Ramsay评分对患者镇静效果进行评价;采用匹兹堡睡眠质量指数量表(PSQI)评价患者睡眠质量;采用流式细胞仪测定不同时间点淋巴细胞亚群CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD^(8+)细胞活性的变化;观察并记录两组患者治疗10 d内不良反应发生情况。 结果:治疗前及治疗后各时间点,HI组患者NRS评分、BTP、Ramsay评分和PSQI评分与HV组比较差异均无统计学意义(NRS: t=0.45,0.91,0.52,1.19,0.97,1.92;BTP: t=0.34,1.88,0.86,1.71,1.22,0.76;Ramsay: t=0.56,0.46,0.63,0.22,0.99,0.14;PSQI: t=0.86,1.25,1.46,1.05,0.57,1.93;均 P > 0.05)。治疗后各时间点,两组患者CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD^(8+)细胞活性均升高,且HI组均高于HV组,差异均有统计学意义(CD_(3)^(+): t=3.72,3.12,2.85,3.13,2.44;CD_(4)^(+): t=3.62,2.45,3.31,3.19,2.70;CD_(4)^(+)/CD^(8+): t=3.10,2.74,2.83,3.24,3.41;均 P < 0.05)。HI组总不良反应发生率为14.00%(7/30),稍低于HV组的26.00%(13/30),差异无统计学意义(χ^(2)=2.70, P=0.100)。。 结论:氢吗啡酮鞘内给药相比于静脉给药治疗难治性癌痛患者,可以有效镇痛,降低爆发痛发生次数,提高睡眠质量,具有良好的镇静效果,可以改善免疫功能,且不良反应发生较少。Objective To investigate the effects of different analgesic methods of hydromorphone on analgesic efficacy and sleep quality in patients with refractory cancer pain.Methods Sixty patients with refractory cancer pain who received three-step analgesic treatment in Quzhou People's Hospital from August 2018 to December 2019 and acquired poor analgesic effects were included in this study.They were randomly assigned to undergo either an intravenous patient-controlled analgesia with hydromorphone(HV group,n=30)or an intrathecal patient-controlled analgesia with hydromorphone(HI group,n=30)for 10 consecutive days.The analgesic efficacy in each group was evaluated using the numerical rating scale(NRS)before and 2,4,24,48 hours,and 10 days after administration.The frequency of breakthrough pain(BTP)at each time point was recorded.The sedation effect of medication was evaluated using the Ramsay score.The sleep quality of patients was evaluated using the Pittsburgh sleep quality index(PSQI).The activities of CD_(4)^(+),CD_(4)^(+),and CD_(4)^(+)/CD^(8+)lymphocyte subsets were measured by flow cytometry at different time points.The adverse reactions within 10 days after treatment were observed and recorded.Results Before and at each time point after treatment,there were no significant differences in NRS score,the frequency of BTP,Ramsay score,and PSQI score between the two groups(NRS score:t=0.45,0.91,0.52,1.19,0.97,1.92,all P>0.05;frequency of BTP:t=0.34,1.88,0.86,1.71,1.22,0.76,all P>0.05;Ramsay score:t=0.56,0.46,0.63,0.22,0.99,0.14,all P>0.05;PSQI:t=0.86,1.25,1.46,1.05,0.57,1.93,all P>0.05).At each time point after treatment,the activities of CD_(4)^(+),CD_(4)^(+),and CD_(4)^(+)/CD^(8+)cells increased in each group,and the activities of CD_(4)^(+),CD_(4)^(+),and CD_(4)^(+)/CD^(8+)cells in the HI group were significantly higher than those in the HV group(CD_(4)^(+):t=3.72,3.12,2.85,3.13,2.44,all P<0.05;CD_(4)^(+):t=3.62,2.45,3.31,3.19,2.70;all P>0.05;CD_(4)^(+)/CD^(8+):t=3.10,2.74,2.83,3.24,3.41,all P<0.05).The total inciden

关 键 词：癌性疼痛 疼痛 顽固性 氢吗啡酮 镇痛 病人控制 睡眠 免疫 

分 类 号：R730.5[医药卫生—肿瘤]