自控静脉镇痛用于居家晚期癌痛患者治疗的效果观察

Effects of patient-controlled intravenous analgesia treatment in patients with advanced cancer

目的探讨居家晚期癌痛患者采用自控静脉镇痛(PCIA)治疗的可行性和有效性。方法 32例Ⅳ期中重度癌性疼痛患者采用吗啡(初始给药剂量根据当时日口服吗啡总量1/3加上日肌注吗啡总量的2/3的2倍作为24 h泵注的连续背景输注剂量)+氟哌利多5 mg+胃复安40 mg用0.9%生理盐水配成100 ml,视患者镇痛效果调节药物浓度,病情需要可应用辅助药,如抗焦虑药/镇静催眠药、激素等。结果患者在PCIA镇痛期间疼痛明显缓解,治疗早期40.6%(13/32)的患者达到完全缓解,93.25%(30/32)的患者癌痛达到中度以上缓解,只有6.2%(2/32)的患者未达到满意效果。随着时间的延长,吗啡剂量的增大,平均初始剂量为(69.5±20.7)mg/d,治疗终点的剂量为(256.5±75.6)mg/d,平均治疗时间为(48.3±13.5)d,生活质量均有一定程度的改善,不良反应轻。结论居家晚期疼痛患者采用自控静脉镇痛治疗具有可行性,且疗效较好。

Objective To investigate the effects of patient-controlled intravenous analgesia treatment in pa-tients with advanced cancer. Methods 32 patients with moderate to severe periodⅣcancer pain were treated with morphine （initial dose of 24 h continuous background infusion was based on a summation of 1/3 of the 24h oral amount plus 2 times of 2/3 of intramuscular injection amount of morphine）＋5 mg droperidol＋40 mg metoclopramide paired with 100ml 0.9%saline. The drug concentration was adjusted according to the analgesic effects in patients. Ad-juvant drugs, such as anxiolytics, sedative hypnotics and hormones, were applied according to condition of patients. Results The pain was relieved in patients with PCIA, achieved complete remission in 40.6%（13/32） patients with early treatment, and achieved moderate remission in 93.25%（30/32） patients with cancer pain. Only 6.2%（2/32） pa-tients did not achieve satisfactory effect. With the extension of time, increasing doses of morphine, mean initial dose was （69.5±20.7） mg/d, the dose was （256.5±75.6） mg/d at the end of the treatment, and the average treatment time was （48.3±3.5） d. The quality of life was improved and adverse reactions were light. Conclusion Patient-controlled intra-venous analgesia is feasibility and effectiveness to treat advanced pain.