右美托咪定联合吗啡皮下注射自控镇痛用于癌性爆发痛的疗效观察

Observation on the efficacy of dexmedetomidine combined with morphine subcutaneous injection of patient-controlled analgesia for cancerous outbreak pain

目的探讨右美托咪定(dexmedetomidine,Dex)联合吗啡皮下注射自控镇痛用于癌性爆发痛(breakthrough cancer pain,BTcP)的效果及安全性。方法选取BTcP患者75例,按随机数字法分为对照组(C组)、吗啡组(M组)和右美托咪定组(D组),每组25例。C组给予盐酸吗啡片口服控制BTcP,M组给予吗啡皮下注射自控镇痛控制BTcP,D组给予Dex联合吗啡皮下注射自控镇痛控制BTcP。记录治疗前(T0)、治疗后第10天(T1)、治疗后第20天(T2)时每天口服吗啡等效剂量(oral morphine equivalent,OME)、BTcP发作次数、基础及BTcP发作时疼痛数字评分(Numerical Rating Scale,NRS)、BTcP缓解时间,使用欧洲癌症研究与治疗组织癌症患者生活质量问卷(The European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30,EORTC QLQ-C30)及自评抑郁量表(Self-Rating Depression Scale,SDS)评价患者生活质量、抑郁水平,记录并发症发生率。结果与T0比较,C组T1、T2时及M组T2时OME增加(P<0.05);与T1比较,C组与M组T2时OME增加(P<0.05);与C组比较,M组T2时及D组T1、T2时OME降低(P<0.05);与M组比较,D组T2时OME降低(P<0.05)。与C组比较,M组BTcP发作时NRS评分,D组BTcP发作时NRS评分及BTcP缓解时间降低(P<0.05);与M组比较,D组爆发痛NRS评分及BTcP缓解时间降低(P<0.05)。3组患者T2时躯体功能、角色功能、情绪功能、总健康状况评分高于T0(P<0.05),T2时3组患者疲劳、恶心呕吐、疼痛、气促、失眠、食欲减退、腹泻,M组与D组便秘评分低于T0(P<0.05),M组与D组T2时躯体功能、情绪功能、总健康状况评分高于C组(P<0.05),M组与D组T2时疼痛评分低于C组(P<0.05),D组T2时躯体功能、角色功能、情绪功能、总健康状况评分高于M组(P<0.05)。与T0比较,3组患者T2时SDS评分及C组、M组T1时SDS评分降低(P<0.05);与C组比较,M组T2时及D组T1、T2时SDS评分降低(P<0.05);与M组比较,D组T1、T2时SDS评分降低(P<0.05)。与C组比较,M组与D组恶心呕吐、小便困难、便秘的发生率降低(P<0.05)。结论Dex联合吗啡皮下注射自控镇痛能更快速地缓解BTcP,降低基础镇痛药物用量,改善患者生活质量及抑郁情绪,降低患者并发症发生率。

Objective To investigate the efficacy and safety of dexmedetomidine(Dex)combined with patient-controlled subcutaneous morphine analgesia in the treatment of breakthrough cancer pain(BTcP).Methods Seventy-five patients with BTcP were divided into control group(group C),morphine group(group M)and dexmedetomidine group(group D)using random number table method(n=25).Group C was given morphine orally to control BTcP.Group M was given morphine injected subcutaneously to control BTcP.Group D was given morphine combined with Dex injected subcutaneously to control BTcP.Record the oral morphine equivalent dose(OME),number of BTcP attacks,Numerical Rating Scale(NRS)score and BTcP remission time were recorded before treatment(T0),10 days after treatment(T1),and 20 days after treatment(T2).The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EORTC QLQ-C30)and Self-Rating Depression Scale(SDS)were used to evaluate the quality of life,depression level scores and record the complication rate.Results Compared with T0,OME was significantly increased at T1,T2 in group C and in group M at T2(P<0.05).Compared with T1,OME in group C and group M increased significantly at T2(P<0.05).Compared with group C,OME in group M decreased significantly at T2 and in group D at T1 and T2(P<0.05).Compared with group M,OME in group D decreased significantly at T2(P<0.05).NRS of BTcP and the relief time of BTcP in group D and the NRS of BTcP in group M was significantly decreased than those in group C(P<0.05).Compared with group M,the NRS of BTcP and the relief time of BTcP in group D were significantly decreased(P<0.05).The scores of physical function,role function,emotional function,and total health status of the three groups of patients at T2 were higher than T0(P<0.05).At T2,fatigue,nausea and vomiting,pain,shortness of breath,insomnia,loss of appetite,and diarrhea were observed in the three groups,the scores of constipation in group M and group D were lower than T0(P<0.05),the scores of physical function,emotional function,and total health at T2 in group M and D were higher than those in group C(P<0.05),and scores of pain in group M and D were lower than those in group C(P<0.05).The scores of physical function,role function,emotional function,and total health status at T2 in group D were higher than those of group M(P<0.05).Compared with T0,the SDS score at T2 of the 3 groups and the SDS score at T1 in group C and M decreased(P<0.05);compared with group C,the SDS score at T2 in group M and at T1 and T2 in group D decreased(P<0.05);Compared with group M,SDS scores of group D decreased at T1 and T2(P<0.05).Compared with group C,the incidence of nausea,vomiting,dysuria,and constipation in group M and group D was lower(P<0.05).Conclusions Dex combined with morphine patient-controlled subcutaneous analgesia can relieve BTcP more quickly,reduce the dosage of basic analgesics,improve the quality of life and depression,and reduce the incidence of adverse reactions.