鞘内泵注吗啡联合加巴喷丁治疗中重度癌性神经痛疗效观察

Curative effects of intrathecal pump injection morphine combined with gabapentin in treatment of moderate-severe cancerous neuralgia

目的研究鞘内泵注吗啡联合加巴喷丁对中重度癌性神经痛患者的止痛效果及临床疗效。方法鞘内泵注药物进行癌痛治疗的90例患者,其中单纯使用吗啡、单纯使用加巴喷丁、联合用药均为30例患者,比较3组患者止痛治疗前后视觉模拟(VAS)评分的差异及具体来源、睡眠质量、补救镇痛药用量和不良反应发生情况(呼吸抑制、低血压、心动过缓、头痛、恶心呕吐)的差异。结果不同时点比较,吗啡组、加巴喷丁组、联合用药组患者VAS评分的差异均有统计学意义(P<0.05);同一时点不同组别的比较,第1周3组患者VAS评分差异无统计学意义(P>0.05),而第2周和第4周3组患者VAS评分差异均有统计学意义(P<0.05);3组患者治疗前后组内VAS评分比较,差异有统计学意义(P<0.01),不同时点差异有统计学意义(F=76.904,P<0.001),时间与分组存在交互作用(P<0.01);3组患者临床疗效比较,睡眠质量评分、补救镇痛药用量构成的差异均有统计学意义(P<0.05;3组患者不良反应发生情况,差异无统计学意义(P>0.05)。结论鞘内泵注吗啡联合加巴喷丁对中重度癌痛患者的治疗效果和疼痛缓解作用优于单独用药情况,3组用药方式、时间因素、处理方法和时间的交互作用对癌痛患者疼痛程度均有不同程度的显著影响。

Objective To observe the analgesic effect and clinical efficacy of intrathecal pump injection morphine combined with gabapentin in treatment of moderate-severe cancerous neuralgia. Methods A total of 90 patients who were treated by intrathecal pump injection drugs in treatment of cancerous neuralgia were divided into morphine analgesia group（ n = 30）,gabapentin analgesia group（ n = 30） and drug combination group（ n = 30）. The differences of Visual Analogue Scale（ VAS） before and after analgesia treatment,source of pain,sleep quality,remedy analgesia drug doseage and occurrence status of adverse reactions including（ respiratory depression,hypotension,bradycardia,headache,nausea and vomiting were observed and compared among the three groups. Results There were significant differences in VAS scores at different time points among the three groups at the same time-point（ P〈0. 05）. One week after treatment there were no significant differences in VAS scores among the three groups（ P〈0. 05）,however at 2 w,4 w treatment there were significant differences in VAS scores among the three groups（ P〈0. 05）. Moreover there were significant differences in VAS scores in each group before and after treatment（ P〈0. 01）,and there were significant differences at different time points（ P〈0. 01）.There was interaction between time and grouping（ P〈0. 01）. In addition there were significant differences in scores of sleep quality and doseage of remedy analgesia drugs among thethree groups（ P〈0. 05）. However there was no significant difference in incidence of adverse reactions among the three groups（ P〈0. 05）. Conclusion The curative effects and pain relaxation effects of intrathecal pump injection morphine combined with gabapentin in treatment of moderate-severe cancerous neuralgia are superior to those by single medication. In addition the medication mode,time factors,processing methods and the interaction of time have effects on pain degree of patients with cancerous pain at different extents.