P-糖蛋白表达阳性对癌痛病人舒芬太尼或喷他佐辛PCIA效果的影响  

Effect of positive P-glycoprotein expression on efficacy of PCIA with sufentanil or pentazocine in patients with cancer pain

作　　者：方志勇 王凌川 王军 丰陈 杨树东 穆会君 查文华 Fang Zhiyong;Wang Lingchuan;Wang Jun;Feng Chen;Yang Shudong;Mu Huijun;Zha Wenhua(Department of Anesthesiology,Nanjing People′s Hospital of Lishui,Nanjing 211200,China;The Clinical Medicine of Beihua University,Jilin 132013,China;Department of Anesthesiology,The Affiliated Wuxi People′s Hospital(Wuxi Medical Center)of Nanjing Medical University,Wuxi 214023,China;Department of Anesthesiology,Nanjing Central Hospital,Nanjing 210018,China;Department of Pathology,The Affiliated Wuxi People′s Hospital(Wuxi Medical Center)of Nanjing Medical University,Wuxi 214023,China;Department of Central Laboratory,The Affiliated Wuxi People′s Hospital(Wuxi Medical Center)of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京市溧水区人民医院麻醉科,南京211200 [2]北华大学临床医学院,吉林132013 [3]南京医科大学附属无锡人民医院(无锡医学中心)麻醉科,无锡214023 [4]南京市中心医院麻醉科,南京210018 [5]南京医科大学附属无锡人民医院(无锡医学中心)病理科,无锡214023 [6]南京医科大学附属无锡人民医院(无锡医学中心)中心实验室,无锡214023

出　　处：《中华麻醉学杂志》2024年第9期1112-1116,共5页Chinese Journal of Anesthesiology

基　　金：南京市卫健委科技发展专项资金项目(YKK20180)。

摘　　要：目的:评价P-糖蛋白表达阳性对癌痛病人舒芬太尼或喷他佐辛PCIA的效果。方法:本研究为回顾性队列研究。收集2020年1月至2024年1月于南京市溧水区人民医院进行治疗的癌痛病人的病历资料,年龄54~71岁,体质量49~67 kg,性别不限,TNM分期Ⅱ-Ⅳ期。采用免疫组织化学法测定肿瘤组织P-糖蛋白表达情况。将肿瘤组织P-糖蛋白表达阴性的病人分为2组:舒芬太尼组(S_(1)组)和喷他佐辛组(P_(1)组);将肿瘤组织P-糖蛋白表达阳性的病人分为2组:舒芬太尼组(S_(2)组)和喷他佐辛组(P_(2)组)。当VAS>5 cm时行PCIA,S_(1)组和S_(2)组采用枸橼酸舒芬太尼2μg/kg+托烷司琼10 mg;P_(1)组和P_(2)组采用喷他佐辛3 mg/kg+托烷司琼10 mg,4组均以生理盐水稀释成100 ml,负荷量5 ml,背景输注速率2 ml/h,PCA剂量1 ml,锁定时间10 min。镇痛期间VAS>3 cm时,静脉注射氟比洛芬酯50 mg补救。记录PCIA 4 h内、>4~12 h、>12~24 h及>24~48 h时段舒芬太尼、喷他佐辛用量和氟比洛芬酯使用情况。记录镇痛期间呼吸抑制(SpO_(2)<90%)、恶心呕吐、皮肤瘙痒及心动过缓等不良反应的发生情况。结果:最终纳入100例患者,每组25例。S_(1)组与S_(2)组各时段舒芬太尼用量、氟比洛芬酯使用率及镇痛期间呼吸抑制、恶心呕吐、皮肤瘙痒及心动过缓发生率比较差异均无统计学意义(P>0.05);与P_(1)组比较,P_(2)组PCIA 4 h内、>4~12 h及>24~48 h时段喷他佐辛用量升高(P<0.05),各时段氟比洛芬酯使用率和镇痛期间呼吸抑制、恶心呕吐、皮肤瘙痒及心动过缓发生率差异无统计学意义(P>0.05)。结论:P-糖蛋白表达阳性可能会减弱癌痛病人喷他佐辛PCIA的效果,而对舒芬太尼PCIA的效果可能无影响。ObjectiveTo evaluate the effect of the positive P-glycoprotein expression on the efficacy of patient-controlled intravenous analgesia(PCIA)with sufentanil or pentazocine in patients with cancer pain.MethodsThis was a retrospective cohort study.The medical records of patients with cancer pain of either sex,aged 54-71 yr,weighing 49-67 kg,with TNM stageⅡ-Ⅳ,who were treated in People′s Hospital of Lishui from January 2020 to January 2024,were collected.The expression of P-glycoprotein in tumor tissues was determined by the immunohistochemical method.Patients with negative P-glycoprotein expression in tumor tissues were divided into 2 groups:sufentanil group(group S_(1))and pentazocine group(group P_(1)).Patients with positive P-glycoprotein expression in tumor tissues were divided into 2 groups:sufentanil group(group S_(2))and pentazocine group(group P_(2)).The patients in 4 groups received 48 h of PCIA when visual analogue scale>5 cm.The PCIA solution contained sufentanil 2μg/kg and tropisetron 10 mg in 100 ml of normal saline in S_(1) and S_(2) groups or pentazocine 3 mg/kg+tropisetron 10 mg in 100 ml of normal saline in P_(1) and P_(2) groups.The PCIA pump was set up to deliver a 1 ml bolus dose with a 10-min lockout interval and background infusion at 2 ml/h after a loading dose of 5 ml.Flurbiprofen 50 mg was intravenously injected when visual analogue scale>3 cm during analgesia.The consumption of sufentanil,pentazocine and flurbiprofen within 4 h,>4-12 h,>12-24 h and>24-48 h of PCIA was recorded.The occurrence of adverse reactions such as respiratory depression(SpO_(2)<90%),nausea or/and vomiting,pruritus and bradycardia was recorded.ResultsOne hundred patients were finally included,with 25 in each group.There was no significant difference in the consumption of sufentanil,usage rate of flurbiprofen and incidence of respiratory depression,nausea and vomiting,pruritus and bradycardia during analgesia at each time period during PCIA between group S_(1) and group S_(2)(P>0.05).Compared with group P_(1),the

关 键 词：ATP结合盒转运体 亚家族B 成员1 舒芬太尼 喷他佐辛 肿瘤 疼痛 镇痛 病人控制 

分 类 号：R730.5[医药卫生—肿瘤] R614[医药卫生—临床医学]