氢吗啡酮与吗啡PCIA滴定治疗癌痛的效果对比

Comparison between hydromorphone and morphine PCIA titration in the treat ment of cancer pain

目的:分析并比较用氢吗啡酮与吗啡对癌性疼痛(癌痛)患者实施病人静脉自控镇痛(PCIA)滴定的效果。方法:选取近年来在云南省某三级医院缓和医学中心安宁病房住院的100例癌痛患者作为研究对象。随机将其分为对照组和观察组,每组各有患者50例。用吗啡对对照组患者实施PCIA滴定,用氢吗啡酮对观察组患者实施PCIA滴定,两组患者均不设置背景剂量,且区分阿片类药物耐受和不耐受患者。比较两组患者治疗后的各项临床指标。结果:与对照组患者中的阿片类药物耐受患者相比,观察组患者中的阿片类药物耐受患者其滴定成功时间更短,滴定成功剂量和24 h用药剂量均更小,24 hPCIA次数更少,P<0.05。与对照组患者中的阿片类药物不耐受患者相比,观察组患者中的阿片类药物不耐受患者其滴定成功剂量和24 h用药剂量均更小,P<0.05。滴定后,两组患者中阿片类药物耐受患者的疼痛数字评分法(NRS)评分均下降至3分以内,提示用氢吗啡酮与吗啡对阿片类药物耐受的癌痛患者实施PCIA滴定的效果均较好。滴定后,与对照组患者中的阿片类药物耐受患者相比,观察组患者中的阿片类药物耐受患者其NRS评分更低,P<0.05。滴定后,两组患者中阿片类药物不耐受患者的NRS评分均下降至2分以内,提示用氢吗啡酮与吗啡对阿片类药物不耐受的癌痛患者实施PCIA滴定的效果均较好。滴定后,两组患者中阿片类药物不耐受患者的NRS评分相比,P>0.05。结论:用氢吗啡酮与吗啡对癌痛患者实施PCIA滴定均是安全有效的,其中氢吗啡酮在快速镇痛中更显优势,滴定成功的时间更短,滴定药量更少,且能更有效地减轻阿片类药物耐受患者癌痛的程度。

Objective:To analyze and compare the effect of patient controlled intravenous analgesia(PCIA)titration with hydromorphone and morphine in patients with cancer pain.Methods:A total of 100 patients with cancer pain who were hospitalized in hospice ward of palliative medicine center of a tertiary hospital in Yunnan province in recent years were selected as subjects.They were randomly divided into control group and observation group,with 50 patients in each group.The control group was titrated with morphine,and the observation group was titrated with hydromorphone.No background dose was set for both groups,and opioid tolerance and intolerance were distinguished.The clinical indexes of the two groups after treatment were compared.Results:Compared with opioid tolerance patients in the control group,opioid tolerance patients in the observation group had shorter titration success time,smaller titration success dose and 24 h drug dose,and fewer 24 hPCIA times(P<0.05).Compared with the opioid intolerance patients in the control group,the successful titrated dose and 24 h dose of opioid intolerance patients in the observation group were smaller,P<0.05.After titration,the pain digital score(NRS)score of patients with opioid tolerance decreased to less than 3 points in both groups,suggesting that hydromorphinone and morphine have a better effect on PCIA titration in patients with opioid tolerance of cancer pain.After titration,opioid tolerance patients in the observation group had lower NRS scores compared with opioid tolerance patients in the control group(P<0.05).After titration,NRS scores of patients with opioid intolerance in both groups decreased to less than 2 points,suggesting that hydromorphone and morphine have a better effect on PCIA titration in patients with opioid intolerance of cancer pain.After titration,NRS scores of patients with opioid intolerance were compared between the two groups,P>0.05.Conclusion:PCIA titration with hydromorphone and morphine is safe and effective in patients with cancer pain,and hydromorphone has more advantages in rapid analgesia,shorter titration success time,less titration drug,and can more effectively reduce the degree of cancer pain in patients with opioid tolerance.