经皮吗啡自控镇痛治疗晚期癌痛临床观察

Clinical Observation on Patient-Controlled Analgesia with Percutaneous Morphine Pumping in Patients Suffering Cancer Pain

目的评价应用自控镇痛微控皮下吗啡给药对晚期癌痛的疗效及安全性。方法对38例晚期癌痛口服阿片类药物效果不佳患者,应用吗啡自控镇痛泵以代替其口服吗啡用药,记录治疗前后疼痛评分(VAS)、生活质量评分-2(QOL-2)及24h吗啡总用量,观察疼痛缓解率及不良反应。结果应用镇痛泵前后VAS评分均值分别为(7.16±0.89)分和(1.79±0.38)分(P<0.01),QOL-2评分均值分别为(28.34±6.57)分和(50.03±8.41)分(P<0.01),治疗前后吗啡日用量分别为(92.60±21.01)mg(口服剂量)和(31.00±9.34)mg(皮下给药)(P<0.01);疼痛缓解率为94.7%(36/38);不良反应主要为便秘、恶心呕吐、尿潴留和精神症状。结论经皮下吗啡给药自控镇痛可有效控制晚期癌痛,具有安全、高效、方便等优点,并降低晚期癌痛患者吗啡药物用量及药物不良反应。

Objective To investigate the efficacy and safety of patient-controlled analgesia with percutaneous morphine pumping in patients with cancer pain. Methods Thirty-eight patients with cancer pain who had unsatis-factory outcome with opioids underwent continuous percutaneous morphine via patient-controlled analgesia pump from July 2012 to July 2013. The visual analogue scale（VAS） and quality of life（QOL） scale and morphine con-sumption within 24h were compared before and after treatment. The total rate of pain relief and adverse events were recorded. Results Before and after treatment,the VAS were 7.16±0.89 and 1.79±0.38, respectively （P〈0.01）, QOL were 28.34±6.57 and 50.03±8.41（P〈0.01）,and morphine consumption with 24 h were（92.6±21.01）mg （oral） and （31.0±9.34）mg （percutaneous）（P〈0.01）. The total rate of pain relief was 94.7%（36/38）. The main adverse events was nausea,vomiting,constipation,urine retention,and mental symptoms. Conclusion Patient-controlled anal-gesia with continuously percutaneous morphine pumping is effective,safe,and convenient in treatment of cancer pain with smaller dosage and mild adverse events.