阿片类药物用于癌痛患者硬膜外自控镇痛对神经功能的影响

The effect of PCEA with opioids on nerve function for patients with cancer pain

目的:观察布托啡诺和舒芬太尼用于癌痛患者硬膜外自控镇痛(patient-controlled epidural analgesia,PCEA)的效果及对神经功能的影响。方法:100例行PCEA的癌痛患者,随机数字表法分为5组:B组(布托啡诺组,n=20);BR组(布托啡诺+罗哌卡因组,n=20);R组(罗哌卡因组,n=20);S组(舒芬太尼组,n=20);SR组(舒芬太尼+罗哌卡因组,n=20)。评估5组患者治疗后疼痛视觉模拟评分(visual analogue scale,VAS)、PCEA使用情况、总体满意度(general satisfaction,GSS)、不良反应、血清髓鞘碱性蛋白(myelin basic protein,MBP)、下肢体感诱发电位(somatosensory evoked potential,SEP)。结果:治疗后与B、S、R组相比,BR、SR组VAS评分降低(P<0.05),患者的GSS增加(P<0.05);BR、SR组的PCEA总量及按压次数明显减少(P<0.05);B组和BR组的不良反应较其他3组明显减少(P<0.05);5组患者治疗后的血清MBP浓度、SEP与治疗前相比差异均无统计学意义(P>0.05)。结论:布托啡诺或舒芬太尼联合罗哌卡因用于癌痛的PCEA镇痛效果优于各自单独使用,同时对血清MBP和SEP无影响。

Objective： To analyze the analgesia effect and influence on nerve function of butrophanol and sufentanil used for patient-controlled epidural analgesia（PCEA） for patients with cancer pain. Methods： A total of 100 patients with cancer pain were randomly divided into five groups： group B（PCEA pump contain butrophanol, n =20）; group BR（PCEA pump contain butrophanol and ropivacaine, n=20）;group R（PCEA pump contain ropivacaine alone, n=20）; group S（PCEA pump contain sufentanil,n=20）;group SR（PCEA pump contain sufentanil and ropivacaine, n=20）. Visual analogue scale（VAS） amount of drugs in PCEA, general satisfaction（ GSS）, adverse reactions, concentration changes of serous myelin basic protein（ MBP） and somatosensory evoked potential（SEP） of both lower limbs and neurological function were observed. Results：VAS of pain in group BR and SR decreased significantly after the treatment（P〈0.05）, but general satisfaction of patients was increased（P〈0.05）.The cumulated dosage of drugs and times of pressing pump in group BR and SR were less than the other groups（P〈0.05）.Adverse reactions occurred less in group B and BR（P〈0.05）. There was no significant difference between preoperative and postoperative concentrations of serous MBP and SEP in all five groups（P〈0.05）. Conclusions： Butrophanol or sufentanil with ropivacaine used for PCEA after pain treatment produces a better quality of analgesia than butrophanol or ropivacaine or sufentanil dose alone, and has no influence in MBP and SEP.