鞘内镇痛在顽固性癌痛患者的应用

Clinical application of intrathecal analgesia in patients with refractory cancer pain

目的探讨鞘内镇痛用于顽固性癌痛患者的临床效果及安全性。方法晚期顽固性癌痛患者50例采用持续鞘内镇痛,镇痛药物分别为吗啡+布比卡因(A组,25例)和吗啡(B组,25例)。比较治疗前后静息/运动VAS疼痛评分,记录吗啡用量,评估生活质量和不良反应。结果与治疗前相比,两组患者镇痛期间VAS疼痛评分均降低(P<0.05),A组患者的运动VAS疼痛评分较B组更低(P<0.05)。A组每日吗啡用量为(4.17±1.25)mg,少于B组的(8.34±1.48)mg(P<0.05)。A组患者的生活质量总评分为(80.24±6.71)分,高于B组的(67.82±6.03)分(P<0.05)。A组镇痛相关的不良反应发生率低于B组(4.00%vs.20.00%)(P<0.05)。结论与单一吗啡比较,持续鞘内输注吗啡联合布比卡因对顽固性癌痛的镇痛效果较好,能减少吗啡的用量和不良反应。

Objective To study the efficacy and safety of intrathecal analgesia for refractory pain in the patients with advanced cancer.Methods Intrathecal analgesia was performed in 50 patients with advanced refractory cancer,who were divided into two groups of A（morphine 0.2 mg/ml＋bupivacaine 0.75mg/ml,25cases）and B（morphine 0.2mg/ml alone,25cases）.The analgesia was evaluated by VAS pain score at rest（rVAS）and movement（mVAS）.The comsumption of morphine was recorded,quality of life was evaluated with GQOL-74 scale and adverse effects were observed.Results The scores of rVAS and mVAS in both groups were significantly lower during intrathecal analgesia than those before（P〈0.05）,which of mVAS were lower in group A than those in group B（P〈0.05）.The daily comsumption of morphine was significantly less in group A than that in group B[（4.17±1.25）mg vs.（8.34±1.48）mg]（P〈0.05）.The quality of life was better in group A than that in group B[（80.24±6.71）points vs.（67.82±6.03）points]（P〈0.05）.The incidence rate of adverse effects was lower in group A than that in group B（4.00% vs.20.00%）（P〈0.05）.Conclusion Compared to morphine alone,intrathecal analgesia with combined use of morphine and bupivacaine can effectively alleviate the refractory cancer pain with less morphine consumption and adverse effects.