比较鞘内输注氢吗啡酮与吗啡治疗晚期难治性癌痛患者的疗效及安全性  

Comparison of the efficacy and safety with intrathecal infusion of hydromorphone or morphine for refractory cancer pain in advanced patients

作　　者：李志华[1] 王春晓 赵梅竹 张鑫[1] 徐贯杰[1] 王仲凯 宛春甫[2] Li Zhihua;Wang Chunxiao;Zhao Meizhu;Zhang Xin;Xu Guanjie;Wang Zhongkai;Wan Chunfu(Department of Anesthesiology,Third Hospital of Hebei Medical University,Shijiazhuang City 050051,China;Department of Painology and Rehabilitation,Forth Hospital of Hebei Medical University,Shijiazhuang City 050011,China)

机构地区：[1]河北医科大学第三医院麻醉一科,石家庄市050051 [2]河北医科大学第四医院疼痛康复科,石家庄市050011

出　　处：《中华疼痛学杂志》2023年第4期563-569,共7页Chinese Journal Of Painology

摘　　要：目的比较鞘内输注氢吗啡酮与吗啡治疗难治性癌痛患者的疗效及安全性。方法本研究为随机对照临床试验,收集2021年11月1日至2022年10月30日在河北医科大学第四医院疼痛康复科进行治疗的晚期结直肠癌难治性癌痛患者90例,年龄≥65岁,性别不限。所有患者均在超声引导下向L_(3~4)间隙置入鞘内输注系统,根据输注药物不同分为鞘内吗啡组(生理盐水稀释盐酸吗啡至300 ml,浓度为0.5 mg/ml)和鞘内氢吗啡酮组(生理盐水稀释盐酸氢吗啡酮至300 ml,浓度为0.1 mg/ml),各45例。比较两组治疗前24 h及治疗后24 h、72 h、1周、1个月(T0~T4)的数字等级评分(NRS)、爆发痛次数。比较两组T1~T4时吗啡等效用量;评估两组T0、T4时疼痛介质[5-羟色胺(5-HT)、P物质(SP)、前列腺素E_(2)(PGE_(2))]的血清水平,比较两组治疗期间不良反应发生情况。结果T0时点两组NRS评分、爆发痛次数比较差异无统计学意义(P均>0.05)。T1~T4时点鞘内氢吗啡酮组NRS评分分别为(5.5±1.7)、(4.1±1.3)、(3.0±0.8)、(1.2±0.3)低于鞘内吗啡组(6.2±1.2)、(5.6±1.1)、(4.7±0.9)、(2.6±0.4),爆发痛次数为(5.2±0.9)、(3.6±0.8)、(2.2±0.7)、(1.0±0.3)低于鞘内吗啡组(6.4±1.2)、(4.5±1.2)、(2.8±0.9)、(1.5±0.4),吗啡等效用量分别为(2.2±0.4)、(2.1±0.4)、(2.0±0.3)、(2.1±0.3)低于鞘内吗啡组(2.8±0.5)、(2.7±0.6)、(2.6±0.5)、(2.6±0.4)(P均<0.05)。治疗1个月后,两组血清5-HT、SP、PGE_(2)水平均低于治疗前,且鞘内氢吗啡酮组治疗后5-HT、SP及PGE_(2)水平均低于鞘内吗啡组(P均<0.05);鞘内氢吗啡酮组不良反应发生率低于鞘内吗啡组[6.7%(3/45例)比22.2%(10/45例),χ^(2)=4.41,P=0.036]。结论鞘内输注氢吗啡酮与吗啡对晚期结直肠癌难治性癌痛患者均有镇痛效果,但鞘内输注氢吗啡酮效果更佳,不良反应更少。Objective To compare the efficacy and safety of intrathecal infusion of hydromorphone and morphine in the treatment of refractory cancer pain in advanced patients.Methods A total of 90 patients with advanced colorectal cancer,aged≥65 years and regardless of gender,in the Department of Painology and Rehabilitation,the Fourth Hospital of Hebei Medical University,from November 1,2021 to October 30,2022,were studied by a randomized controlled clinical trial.All patients were implanted intrathecal infusion system through the L3-4 space under the guidance of ultrasound and were divided into intrathecal morphine group(normal saline diluted morphine to 300 ml,at a concentration of 0.5 mg/ml)and intrathecal hydromorphone group(normal saline diluted hydromorphone to 300 ml,at a concentration of 0.1 mg/ml),45 cases in each group.NRS and the number of breakthrough pain were compared before the treatment(T0),and after the treatment 24 h(T1),72 h(T2),1 week(T3)and 1 month(T4).The equivalent dose of morphine from T1 to T4 was compared between the two groups.The levels of pain mediators[5-hydroxytryptamine(5-HT),substance P(SP)and prostaglandin E_(2)(PGE_(2))]at T0 and T4 were evaluated in the two groups,and the occurrence of adverse reactions during the treatment was compared between the two groups.Results There was no significant difference in pain score and breakthrough pain between the two groups at T0(all P>0.05).NRS was lower in intrathecal hydromorphone group[(5.5±1.7),(4.1±1.3),(3.0±0.8)and(1.2±0.3)]than that of intrathecal morphine group[(6.2±1.2),(5.6±1.1),(4.7±0.9)and(2.6±0.4)];the number of breakthrough pain was lower in intrathecal hydromorphone group(5.2±0.9),(3.6±0.8),(2.2±0.7),(1.0±0.3)than that in intrathecal morphine group(6.4±1.2),(4.5±1.2),(2.8±0.9),(1.5±0.4),respectively at T1-T4.The equivalent dose of morphine was lower(2.2±0.4),(2.1±0.4),(2.0±0.3)and(2.1±0.3)in intrathecal hydromorphone group than that in intrathecal morphine group(2.8±0.5),(2.7±0.6),(2.6±0.5)and(2.6±0.4),respecti

关 键 词：氢吗啡酮 鞘内输注 难治性癌痛 疗效 安全性 

分 类 号：R735.34[医药卫生—肿瘤]