盐酸氢吗啡酮PCA静脉泵入治疗难治性癌痛的疗效

Efficacy of patient-controlled analgesia intravenous pump of hydromorphone in the treatment of refractory cancer pain

目的观察静脉泵入盐酸氢吗啡酮患者自控镇痛(PCA)治疗难治性癌痛的疗效。方法选取银川市第一人民医院肿瘤科2020年6月至2021年6月收治的难治性癌痛住院患者120例, 按随机数字表法分为口服药物组和PCA泵组, 每组60例。口服药物组患者采用常规口服盐酸羟考酮缓释片±辅助药物镇痛治疗;PCA泵组采用盐酸氢吗啡酮PCA静脉泵入治疗。比较所有患者治疗后4、24、48、72 h疼痛数字等级评分(NRS);比较两组患者治疗前24 h与治疗开始后24 h内的爆发痛发生情况;比较治疗开始后4、72 h的镇痛效果;比较治疗开始后72 h内恶心、呕吐、过度镇静和呼吸抑制等不良反应的发生情况。结果与治疗前比较, 所有患者治疗后不同观察时点NRS均降低, 且差异均有统计学意义(P均<0.05);与口服组比较, PCA泵组患者术后各观察时点NRS均较低, 差异均有统计学意义(P均<0.05);术后PCA泵组患者的恶心、呕吐、过度镇静、呼吸抑制发生率均低于口服组, 差异均有统计学意义(P均<0.05);疼痛控制率明显高于口服组, 且差异存在统计学意义(P<0.05);治疗开始后24 h爆发痛发生次数, PCA泵组患者明显少于口服药物组, 差异均有统计学意义(P均<0.05)。结论盐酸氢吗啡酮PCA静脉泵入治疗难治性癌痛是一种安全有效的方法。

Objective To observe the efficacy of patient-controlled analgesia(PCA)injected intravenously with hydromorphone hydrochloride in the treatment of refractory cancer pain.Methods sAtotal of 120 patients with refractory cancer pain admitted to the Department of Oncology,The First People's Hospital of Yinchuan from June 2020 to June 2021 were divided into oral drug group and PCA pump group in random number table method,with 60 patients in each group.Patients in the oral drug group were treated with conventional oral oxycontin±adjuvant analgesia;patients in the PCA pump group were treated with hydromorphone hydrochloride PCA intravenous pump.Numerical rating scale(NRS)of all patients were compared at 4,24,48 and 72 h after treatment.The occurrence of explosive pain was compared between the two groups 24 h before and 24 h after the start of treatment.The analgesic effects were compared at 4 and 72 h after the start of treatment.Adverse reactions such as nausea,vomiting,excessive sedation and respiratory depression were compared at 72 h after the start of treatment.Results Compared with before treatment,the NRS of all patients decreased at different observation time points after treatment,and the differences were statistically significant(all P<0.05);compared with the oral drug group,the NRS of PCA pump group was lower at different observation time points after treatment,and the differences were statistically significant(all P<0.05).The incidence of postoperative nausea,vomiting,excessive sedation and respiratory depression in the PCA pump group was lower than that in the oral drug group,and the difference was statistically significant(P<0.05);the pain control rate in the PCA pump group was significantly higher than that in the oral drug group,and the difference was statistically significant(P<0.05).The number of pain outbreaks in PCA pump group was significantly less than that in oral drug group 24 h after the start of treatment,and the differences were statistically significant(all P<0.05).Conclusion Hydromorphone hydrochloride PCA is a safe and effective method for the treatment of refractory cancer pain.