鞘内泵入吗啡联合地塞米松治疗癌性骨痛的随机对照研究

Randomized controlled clinical study on combination of morphine and dexamethasone through intrathecal pumping injection in patients with cancer-induced bone pain

目的 :研究鞘内连续注射吗啡联合地塞米松治疗癌性骨痛(cancer-induced bone pain,CIBP)的疗效及其机制。方法:76例CIBP患者均接受椎管内镇痛药输注港皮下植入术,并随机分入吗啡组(A组38例,鞘内泵入吗啡)和吗啡联合地塞米松组(B组38例,鞘内泵入吗啡和地塞米松)。于治疗前以及治疗开始后第1、3、7天评定11点数字评分量表(11-Point Numeric Rating Scale,NRS-11)评分、每日爆发痛次数、生活质量和SF-36量表评分。治疗开始后第7天测定血浆内啡肽和胃动素以及脑脊液中前列腺素E2、P物质和降钙素基因相关肽的水平。结果:B组疼痛缓解效果明显,治疗开始后第1、3、7天的每日爆发痛次数均明显少于A组(P<0.05);2组治疗后的NRS-11评分均<2分,但2组之间NRS-11评分的差异无统计学意义;B组治疗开始后第3和7天的SF-36量表评分和生活质量均较A组有显著改善(P<0.05)。治疗开始后第7天,2组的血浆内啡肽水平差异无统计学意义(P>0.05),但B组的血浆胃动素水平高于A组(P<0.05);B组脑脊液中前列腺素E2、P物质和降钙素基因相关肽水平均低于A组(P<0.05)。结论:鞘内泵入吗啡联合地塞米松与鞘内泵入吗啡相比,可减少CIBP的爆发痛次数,改善患者的生活质量;并可升高血浆胃动素水平,降低脑脊液中前列腺素E2、P物质和降钙素基因相关肽的水平,减轻吗啡耐受,增强镇痛效果。

Objective： To investigate the effcacy of patients with cancer-induced bone pain（CIBP） treated with morphine in combination with dexamethasone through intrathecal pumping injection and its mechanism.Methods： Seventy-six patients with CIBP undergoing implantation of an infusion port with intrathecal catheter were randomly dividedin to group A（n = 38, intrathecally injected with morphine alone and group B（n = 38, intrathecally injected with morphine in combination with dexamethasone）. The pain relief degree by 11-Point Numeric Rating Scale（NRS-11） score, the frequency of breakthrough pain, quality of life and SF-36 scale score were evaluated before treatment and the1 st, 3rd and 7th days after the beginning of intrathecal pumping. Ont he 7th day after treatment, the concentrations of β-endorphin（β-EP） and motilin in plasma as well as prostagland in E2（PGE2）, substance P（SP） and calcitonin gene-related peptide（CGRP） in cerebrospinal fluid（CSF） were determined.Results： The pain was relieved significanly in group B, and the frequencies of breakthrough pain per day were less than those in group A on the 1st, 3rd and 7th days after treatment（all P 〈 0.05）; the NRS-11 score was 〈 2 in two groups after treatment, but there was no significant difference between the two groups（P 〉 0.05）; in group B, the SF-36 scale score and quality of life were both improved significantly on the 3rd and 7th days after treatment as compared withth ose of group A（all P 〈 0.05）. On the 7th day after treatment, thee ndorphin level in plasma was not significantly different between the two groups（P 〉 0.05）,but the motilin level in plasma in group B was significantly higher than that in group A（P 〈 0.05）; the PGE2, SP and CGRP levels in CSF in group B were significantly lower than those in group A（all P 〈 0.05）.Conclusion： Intrathecal pumping injection of morphine in combination with dexamethasone can be of great help in decreasing the frequency of breakthrough of CIBP, improving the quality of life, and increasing the motilin level in plasma, but decreasing PGE2, SP andC GRP levels in CSF which may contribute to alleviating the tolerance of morphine,thus enhance the analgesic effect.