鞘内连续注射吗啡和地塞米松在癌性骨痛中的疗效及其机制

The curative effect and mechanism of continuous intrathecal infusion of morphine and dexamethasone in the treatment of bone cancer pain

目的探讨鞘内连续注射吗啡和地塞米松在癌性骨痛中的疗效及其机制。方法收集86例癌性骨痛患者,按照抽签法分作对照组与观察组,每组各43例。对照组予以鞘内连续注射吗啡治疗,观察组予以鞘内连续注射吗啡和地塞米松治疗,比较两组治疗后降钙素基因相关肽(CGRP)、前列腺素E-2(PGE2)、β-内啡肽(β-EP)水平、疼痛、生活质量及健康状况变化和不良反应。结果治疗后,观察组CGRP、PGE2及β-EP水平均低于对照组,差异均有统计学意义(P﹤0.05);观察组疼痛缓解、生活质量、健康状况均优于对照组,差异均有统计学意义(P﹤0.05);两组患者不良反应发生率比较差异无统计学意义(P﹥0.05)。结论癌性骨痛患者鞘内连续注射吗啡和地塞米松的效果确切,能够通过降低CGRP、PGE2、β-EP水平,减轻患者中枢神经痛觉敏化,提高镇痛效果。

Objective To study the curative effect and mechanism of continuous intrathecal infusion of morphine and dexamethasone in the treatment of bone cancer pain. Method 86 cases of cancer patients with bone pain were included in the study, and were randomized as control group and study group, with 43 cases in each. Control group was given con-tinuous intrathecal infusion of morphine, while study group was administered with continuous intrathecal infusion of mor-phine and dexamethasone, and then the calcitonin gene related peptide （CGRP）, prostaglandin E-2 （PGE2）, beta-endor-phin （β-EP） levels, pain, quality of life and health status changes, as well as adverse reactions in the two groups after treat-ment were compared. Result After treatment, the study group had lower levels of CGRP, PGE2 andβ-EP than control group, with significant difference observed （P〈0.05）;And the study group were superior in respect of pain relief, quality of life, and health status than the control group （P〈0.05）;As for the incidence of adverse reaction, similar results were ob-served in both groups （P〉0.05）. Conclusion Continuous intrathecal infusion of morphine and dexamethasone is demon-strated to be effective in treating bone pain in cancer patients by lowering the level of CGRP, PGE2, andβ-EP, which alle-viates the sensitization of central nervous algesthesia and improves the effect of analgesia.