右美托咪定混合亚麻醉剂量氯胺酮PCIA对晚期癌痛患者焦虑抑郁情绪的影响

Effect of PCIA with dexmedetomidine mixed with subanesthetic dose of ketamine on anxiety and depression in patients with advanced cancer pain

目的评价右美托咪定混合亚麻醉剂量氯胺酮PCIA对晚期癌痛患者焦虑抑郁情绪的影响。方法选取晚期癌痛患者60例,年龄24~82岁,经三阶梯止痛治疗,镇痛效果欠佳或不良反应明显,采用随机数字表法分为2组(n=30):常规治疗组(R组)和右美托咪定混合氯胺酮组(DK组)。R组初始吗啡PCIA剂量为口服剂量的1/3;DK组在R组的基础上加入氯胺酮5.4 mg/kg(90μg·kg^-1·h^-1)及右美托咪定6μg/kg(0.1μg·kg^-1·h^-1)。2组镇痛药物均加入托烷司琼8 mg并用生理盐水稀释至200 ml;首次剂量4 ml,背景剂量4 ml/h,PCA剂量4 ml,锁定时间15 min。于PCIA前、PCIA 4、12、24和48 h时记录数字评定量表(NRS)评分、Ramsay评分、状态-特质焦虑问卷中文版评分和贝克抑郁量表(BDI-Ⅱ)评分。记录PCIA 48 h内镇痛有效和镇静满意情况、抑郁发生情况和程度、生活质量评分和满意度评分、吗啡用量及便秘、恶心呕吐、躁动和呼吸抑制等不良反应的发生情况。结果与R组比较,DK组NRS评分降低,镇痛有效率升高,BDI-Ⅱ和状态焦虑评分降低,抑郁发生率降低,程度减轻,恶心呕吐和便秘发生率、吗啡用量及PCIA泵按压次数降低,生活质量评分和满意度评分升高(P<0.05)。结论右美托咪定混合亚麻醉剂量氯胺酮PCIA用于晚期癌痛患者,能显著增强镇痛效果,改善患者焦虑抑郁情绪,提高生活质量。

Objective To evaluate the effect of patient-controlled intravenous analgesia(PCIA)with dexmedetomidine mixed with subanesthetic dose of ketamine on anxiety and depression in the patients with advanced cancer pain.Methods Sixty patients of either gender with advanced cancer pain,aged 24-82 yr,with poor analgesic effect or obvious adverse reactions after three-step analgesic treatment,were selected and randomly divided into 2 groups(n=30 each)using a random number table method:routine treatment group(group R)and dexmedetomidine mixed with ketamine group(group DK).The initial dose of morphine for PCIA was 1/3 of the oral dose in group R.In group DK,ketamine 5.4 mg/kg(90μg·kg^-1·h^-1)and dexmedetomidine 6μg/kg(0.1μg·kg^-1·h^-1)were added on the basis of group R.Tropisetron 8 mg was added to analgesics and diluted to 200 ml with normal saline in both groups.The analgesic pump was programmed to deliver 4 ml with an initial dose of 4 ml,lockout interval of 15 min and background infusion at 4 ml/h.The numerical rating scale score,Ramsay sedation score,Chinese version of State-Trait Anxiety Inventory score and Beck Depression Inventory-Ⅱscore were recorded before PCIA and at 4,12,24 and 48 h of PCIA.The development of effective analgesia and satisfactory sedation,occurrence and degree of depression,score for patient's quality of life and satisfaction score,consumption of morphine and adverse reactions such as constipation,nausea and vomiting,agitation and respiratory depression were recorded within 48 h of PCIA.Results Compared with group R,the NRS score was significantly decreased,the rate of effective analgesia was increased,Beck Depression Inventory-Ⅱscore and Chinese version of State-Trait Anxiety Inventory score were decreased,the incidence and degree of depression were decreased,incidence of nausea and vomiting and constipation,consumption of morphine and pressing times of PCIA pump were decreased,and the score for patient's quality of life and satisfaction score were increased in group DK(P<0.05).Conclusion PCIA with dexmedetomidine mixed with subanesthetic dose of ketamine can significantly enhance the analgesic effect,improve anxiety and depression,and raise the quality of life when used for the patients with advanced cancer pain.