氢吗啡酮与吗啡鞘内输注对顽固性癌痛患者疼痛的影响

Effect of Hydromorphone Versus Morphine Intrathecal Infusion on Pain in Patients with Intractable Cancer Pain

目的探讨氢吗啡酮与吗啡鞘内输注对顽固性癌痛患者疼痛介质和应激激素水平的影响。方法选取我院疼痛科收治的82例顽固性癌痛患者,随机分为观察组和对照组,各41例。对照组给予鞘内吗啡患者自控镇痛,观察组给予鞘内氢吗啡酮患者自控镇痛。记录两组患者测试前1d、自控镇痛后1d、出院时、术后30d、60d、90d NRS评分、疼痛爆发次数和疼痛介质、应激激素水平以及给药前、给药后2、4、8、24、48h等各时间点镇静Ramsay评分情况。结果两组组内各时间点NRS评分较测试前显著降低(P<0.05),两组间无差异(P>0.05)。两组患者术后60d和术后90d爆发疼痛次数较鞘内自控镇痛后1d和出院时显著降低(P<0.05)。观察组患者疼痛介质和应激激素水平显著低于对照组(P<0.05)。两组患者给药后各时间点Ramsay评分较给药前显著提高,且观察组高于对照组(P<0.05)。结论对顽固性癌痛患者采取氢吗啡酮鞘内输注镇痛效果显著,还可有效降低患者5-HT、NO、PGE2、Cor、GH、PRL等疼痛介质和应激激素水平,镇静效果好。

Objective To investigate the effects of intrathecal infusion of hydromorphone and morphine on the levels of pain mediators and stress hormones in patients with intractable cancer pain.Methods A total of 82 patients with intractable cancer pain treated in our pain department were randomly divided into an observation group and a control group,with 41 patients in each group.The control group received intrathecal morphine for patient-controlled analgesia,while the observation group received intrathecal hydromorphone for patient-controlled analgesia.The NRS scores,number of outbreaks of pain,pain mediators,stress hormone levels,and administration of the two groups of patients 1 day before the test,1 day after patient-controlled analgesia,at discharge,1 month,2 months,and 3 months after surgery Sedation Ramsay scores at each time point before and after administration 2h,4h,8h,24h,48h.Results The NRS scores at each time point within both groups significantly decreased compared to before the test(P<0.05),with no difference between the two groups(P>0.05).The number of pain breakthroughs at 60 and 90 days after surgery in both groups was significantly lower than that at 1 day after intrathecal patient-controlled analgesia and at discharge(P<0.05).The levels of pain mediators and stress hormones in the observation group were significantly lower than those in the control group(P<0.05).The Ramsay scores at each time point after medication were significantly higher than before medication in both groups,with the observation group higher than the control group(P<0.05).Conclusion The effect of intrathecal infusion of hydromorphone for analgesia in patients with intractable cancer pain is remarkable,and it can also effectively reduce the levels of pain mediators and stress hormones such as 5-HT,NO,PGE2,Cor,GH,PRL and other pain mediators of the patients with good sedation effect.