右美托咪定复合亚麻醉剂量氯胺酮对难治性癌痛患者静脉自控镇痛的效果

Analgesic effect of dexmedetomidine combined with sub-anesthetic ke-tamine intravenous patient-controlled analgesia in patients with refracto-ry cancer pain

目的观察右美托咪啶复合亚麻醉剂量氯胺酮静脉自控镇痛(PCIA)对难治性癌痛患者的镇痛效果。方法选取经三阶梯止痛治疗效果欠佳或不良反应明显的晚期癌痛患者共60例,随机分为两组,对照组(C组)和右美托咪啶复合亚麻醉剂量氯胺酮组DK组,在对照组的基础上加入右美托咪啶12μg/kg[0.1μg/(kg·h)]及氯胺酮10.8 mg/kg[90μg/(kg·d)]。每组各30例,均采用PCIA,记录两组患者PCIA前、PCIA后1 d、2 d、5 d、10 d时的VAS评分、OAA/S评分、每日吗啡等效用量及不良反应的发生情况。结果两组患者的VAS评分在PCIA后不同时段均较PCIA前降低(P<0.05);DK组患者的VAS评分在PCIA后不同时段均较C组降低(P<0.05)。DK组患者的OAA/S评分在PCIA后不同时段均较PCIA前升高(P<0.05)。DK组患者每日吗啡等效用量及不良反应均少于C组(P<0.05)。结论右美托咪啶复合亚麻醉剂量氯胺酮PCIA可以增强难治性癌痛患者的镇痛效果、减少吗啡的使用量,减少不良反应。

Objective To explore the analgesic effect and safety of dexmedetomidine combined with sub-anesthetic ke-tamine patient-controlled intravenous analgesia(PCIA)in patients with advanced cancer pain.Methods Sixty patients with advanced cancer pain hospitalized in the First People's Hospital of Suqian from October 2017 to November 2019 who had inadequate response to three-step analgesia or obvious adverse events were selected.They were divided into two groups using the random number table method,as the control group(group C)and the dexmedetomidine combined with ketamine group(DK group).The VAS score,OAA/S score,patient quality of life and satisfaction score before PCIA(T0),at 1 d(T1),2 d(T2),5 d(T3),10 d(T4)after PCIA,daily equivalent dosage of morphine,and occurrence of adverse events,such as constipation,nausea,vomiting and lethargy,of the two groups were recorded.Results The VAS scores of the two groups at T1-T4 were significantly lower than those at T0(P<0.05).The VAS scores of the DK group at T1-T4 were significantly lower than those of group C(P<0.05).The OAA/S scores of the DK group at T1-T4 were significantly higher than those at T0(P<0.05).The quality of life and satisfaction scores of the two groups at T1-T4 were significantly higher than those at T0(P<0.05).The quality of life and satisfaction scores of the DK group at T1-T4 were significantly higher than those of group C(P<0.05).The daily equivalent dosage of morphine,occurrence of nausea,vomiting and con-stipation in the DK group were significantly lower than those in group C(P<0.05).Conclusion Dexmedetomidine com-bined with sub-anesthetic ketamine PCIA can enhance the analgesic effect in patients with advanced cancer pain,de-crease the use of morphine,reduce occurrence of adverse events,and improve the quality of life and satisfaction of pa-tients.