重度癌痛患者应用吗啡持续静脉泵入法进行快速滴定的临床观察

A clinical observation on the rapid dosage titration of continuous intravenous morphine infusion for the treatment of severe cancer pain

目的:观察吗啡静脉持续泵入法对重度癌性疼痛患者进行快速滴定的疗效和优势。方法:7例重度癌性疼痛患者,采用静脉输液泵(型号SY-1200),进行吗啡快速滴定。滴定前计算24h所需静脉吗啡的总量,以其总量的10%做为滴定的起始剂量。设定在15分钟内匀速静脉泵入,每隔15min评估疗效和不良反应,调整吗啡泵入速度。以疼痛评分降至1-3分的有效止痛剂量,然后计算24h所需吗啡的总量,最终制定个体化的止痛给药方案。结果:7例重度癌性疼痛患者均在24小时内完成了吗啡快速滴定,使疼痛评分降至1-3分;其中1例在滴定过程中嗜睡,及时下调剂量后,不良反应缓解。结论:采用吗啡静脉持续泵入的方法进行吗啡滴定可以迅速起效镇痛,明显缩短吗啡滴定时间,血清吗啡浓度可维持恒定有效水平,避免吗啡静推所致的波峰和波谷现象,并且不良反应可控,安全性强。

Objective：To observe the effect and advantage of the morphine dosage titration via continuous intrave-nous infusion for the treatment of severe cancer pain. Methods：Seven patients with severe and prolonged pain were enrolled in the study. Titration：use intravenous infusion pump（ type SY-1200）to give continuous intravenous mor-phine infusion. Titration of the starting dose was about 10% of the total morphine,which was the amount of 24h nee-ded intravenous morphine. Start pumping speed was determined,and the effect and adverse reactions were evaluated every 15min. So the speed of morphine pumping was adjusted. Then the amount of morphine for 24h can be calculat-ed,according morphine effective dose when pain score dropped to 1-3 points. Final individualized treatment of pain were established. Results：All 7 patients with severe cancer pain were quickly completed the morphine titration in 24 hours,whose NRS were declined to 1 -3. 1 case of drowsiness during the process of titration,the adverse reactions were eliminated after lower doses in a timely manner. Conclusion：The dosage titration of continuous intravenous mor-phine infusion can be maintained a constant level effectively,avoiding the phenomenon of peaks and troughs,and side effects can be controlled. This method is safe.