自控蛛网膜下腔吗啡镇痛治疗难治性晚期癌痛

Efficacy of subarachnoid morphine by patient-controlled analgesia for the patient with intractable cancer pain

目的观察患者自控蛛网膜下腔吗啡镇痛治疗难治性癌痛的临床效果及不良反应。方法晚期癌症患者12例,在蛛网膜下腔置管,将导管埋入皮下隧道,外接PCA泵,药盒内每100 ml 生理盐水含吗啡20mg,采用首量+连续+自控模式(LCP),首剂量吗啡0.5mg,维持量吗啡20-30 μg/h, PCA为20 μg/次,锁定时间20 min。结果镇痛时间最短为10日,最长为32d,治疗前12例VAS评分均>5分,治疗后1-14d 10例疼痛完全缓解,均为0分,有2例为1-2分,14d后有9例仍为0分,吗啡平均用量为(1.3±0.5)mg/d。不良反应有恶心、呕吐、尿潴留、皮肤瘙痒,发生率以第1周多见,两周过后各种不良反应明显下降,无感染发生。结论患者自控蛛网膜下腔吗啡镇痛用于晚期癌痛治疗, 药物剂量小、镇痛效果确切,是难治性晚期癌痛WHO三阶梯药物治疗以外的一种良好的辅助及补救方法。

Objective To observe the efficacy of subarachnoid morphine by patient-controlled analgesia in patient with cancer pain . Methods 12 patients with cancer pain were included in this study.The catheter was placed into subarachnoid space and connected with a PCA pump,and LCP mode was adopted. Loading dose of morphine was 0.5mg and background dose from 20 to 30 μg/h. A bolus dose was 20 μg and lockout time was 20 minutes.Pre-and post-treatment, VAS scores and dosage of morphine were recorded. Blood pressure,heart rate,respiratory rate and adverse reactions were monitored daily. Result Duration of analgesia was from 10 to 32 days.The pre-treatment VAS score of the 12 patients was more than 5.From day 1 to day 14 post-treatment, 10 patients were completely pain free, VAS in other 2 patients was 1 to 2.After 14 days,the VAS scores of 9 patients were still zero.The average morphine dosage was (1.3±0.5)mg per day. The side effects included nausea,vomiting,urinary retention and itchy, which were higher in the first week and decreased significantly 2 weeks later.No infectious events occurred in the study. Conclusion Intrathecal injection of morphine into subarachnoid space by PCA is a good supplemental approach for WHO three-steps analgesic ladder in patients with intractable cancer pain.