鞘内注射右旋美托咪定对晚期癌痛患者行吗啡鞘内镇痛的影响

EFFECTS OF DEXMEDETOMIDINE ON SPINAL MORPHINE ANAIGESIA IN TERMINAL CANCER PAIN PATIENTS

目的:评估右旋美托咪定鞘内注射对于晚期癌痛患者行吗啡鞘内镇痛的影响。方法:选择24例晚期癌痛患者,静脉滴定后均采取鞘内镇痛方式。术后分为两个阶段:第一阶段单用吗啡(M阶段);第二阶段吗啡+右旋美托咪定混合液(M+D阶段)。采用双盲交叉法,所有患者随机分配进入M阶段和M+D阶段,待获得48小时满意的镇痛后交叉进行另一阶段鞘内滴定。记录静脉滴定后、M阶段和M+D阶段疼痛评分、满意度、有效吗啡剂量以及生活质量评分。并观察获得满意镇痛后每阶段主要不良反应的发生率。结果:各研究阶段疼痛程度评分差异无统计学意义。M+D阶段与M阶段相比有效吗啡剂量显著降低。患者满意度和生活质量评分术后较术前明显提高,但M+D阶段与M阶段相比差异并无统计学意义。鞘内给药后便秘、恶心、呕吐发生率显著减少。M+D阶段嗜睡发生率显著增加。其余不良反应发生率差异无统计学意义。所有患者均未出现呼吸抑制、低血压、心动过缓和高血压等严重不良反应。结论:鞘内注射右旋美托咪定可加强鞘内吗啡镇痛作用,显著减少吗啡用量,并无严重不良反应发生。

Objective：To evaluate effects of dexmedetomidine on spinal morphine analgesia in terminal cancer pain patients.Methods：Twenty-four patients with terminal cancer pain were enrolled in this study.Intravenous morphine titration was conducted before intrathecal analgesia.After implantation,a two-phase protocol was used in which patients were randomized into a double blind,cross over treatment.In phase M,morphine was given alone by patient-controlled intrathecal analgesia; in phase M＋D,a combination of dexmedetomidine and morphine were given by patient-controlled intrathecal analgesia.The dose of morphine was titrated upwards until satisfactory pain relief was achieved and lasted 48 hrs.Pain intensity,dose of morphine,Treatment satisfaction and quality of life were evaluated by patient-reported questionnaires.Side effects were carefully observed and recorded by physicians.Results：No statistical significance was found in pain intensity on the day before intrathecal administration and at the last days of phase M and M＋D.The dosage of morphine was significantly reduced on the last day of phase M＋D compared with phase M （P 〈 0.05）.Treatment satisfaction and quality of life were significantly improved after intrathecal drug administration.But there were no statistical significance between phase M and M＋D.Constipation,nausea and vomiting were significantly reduced after intrathecal administration （P 〈 0.05）.The incidence of somnolence was significantly increased on the last day of phase M＋D.No serious side effects were observed in this study.Conclusion：The data in this study demonstrates that dexmedetomidine enhances the analgesic effecacy of morphine,as shown by the clecrease of the dose of intrathecal morphine.