右美托咪啶复合吗啡在顽固性癌痛患者中的临床应用

Clinical application of dexmedetomidine combined with morphine in treatment of intractable cancer pain

目的 探讨右美托咪啶复合吗啡对顽固性癌痛患者静脉自控镇痛（PCIA）效果的影响.方法 选择顽固性癌痛患者40例,按随机数字表法分为试验组和对照组,每组20例.试验组药物组成：吗啡200 mg＋右美托咪啶1.0 mg＋昂丹司琼16 mg＋ 0.9％氯化钠.对照组药物组成：吗啡200 mg＋昂丹司琼16 mg＋ 0.9％氯化钠.两组镇痛液容量均为200 ml.试验组静脉缓慢泵注（10 min）负荷剂量右美托咪啶0.5μg/kg后开始PCIA,对照组泵注同样体积的0.9％氯化钠后开始PCIA.记录两组给药前2h和给药后2,4,8,16,32和48 h的视觉模拟量表（VAS）评分,给药后各时间点Ramsay镇静评分,给药后48 h内自控镇痛泵按压次数及吗啡总消耗量、不良反应（低血压、心动过缓、呼吸抑制、恶心呕吐）发生情况.结果 与给药前2h比较,两组给药后各时间点VAS评分明显降低,差异有统计学意义（P＜0.01）.试验组给药后各时间点Ramsay镇静评分显著高于对照组,48 h内自控镇痛泵按压次数明显低于对照组[（4.5±2.2）次比（18.4±5.4）次],吗啡总消耗量明显少于对照组[（90.8 ±7.2） mg比（100.5±10.5） mg],恶心呕吐发生率明显低于对照组,差异有统计学意义（P＜0.01）,两组呼吸抑制和低血压的发生率比较差异无统计学意义（P＞0.05）.结论 右美托咪啶复合吗啡用于顽固性癌痛患者可增强镇痛效果和镇静效果,降低吗啡使用剂量.

Objective To explore the effect of dexmedetomidine combined with morphine in intractable cancer pain with patient-controlled intravenous analgesia （PCIA）.Methods Forty patients with intractable cancer pain were divided into experiment group and control group by random digits table method with 40 cases each.Composition of experiment group：morphine 200 mg ＋ dexmedetomidine 1.0 mg ＋ ondansetron 16 mg ＋ 0.9% sodium chloride.Composition of control group：morphine 200 mg＋ ondansetron 16 mg ＋ 0.9% sodium chloride.Both analgesic fluid volume were 200 ml.The patients in experiment group were administrated 10 min with 0.5 μg/kg dexmedetomidine then received PCIA,the patients in control group were administrated 10 rmin with equal 0.9% sodium chloride then received PCIA.The visual analogue scale （VAS） score was recorded 2 h before administration and 2,4,8,16,32,48 h after administration.Ramsay sedation score was recorded at all the time points after administration.The press number of patient-controlled analgesia pump and dosage of morphine in 48 h after administration,incidence of side effects （low pressure,bradycardia,respiratory inhibition,nausea and vomiting） were recorded.Results Compared with 2 h before administration,the VAS score was significantly lower at every time point after administration in the 2 groups,there was statistical difference （P 〈 0.01）.The Ramsay sedation score at every time point after administration in experiment group was significantly higher than that in control group,the press number of patient-controlled analgesia pump in 48 h was significantly lower than that in control group [（4.5 ± 2.2） times vs.（18.4 ± 5.4） times],dosage of morphine was significantly lower than that in control group [（90.8 ±7.2） mg vs.（100.5 ± 10.5） mg,the incidence of nausea and vomiting was significantly lower than that in control group,there were statistical differences （P 〈 0.01）.However,there were no significant differences in the incidence of respiratory depression and low pressure between the 2 groups （P 〉 0.05）.Conclusion Dexmedetomidine combined with morphine in the treatment of intractable cancer pain can effectively improve the analgesic effect and sedative effect,reduce the dosage of morphine.