小剂量氯胺酮辅助吗啡自控镇痛治疗晚期癌痛的临床研究

目的:观察小剂量氯胺酮辅助吗啡硬膜外、静脉或皮下自控镇痛用于顽固性中、重度晚期癌痛患者的可行性及止痛效果。方法:选择78例中、重度晚期癌痛患者,均为虽经三阶梯药物治疗方案治疗未能很好地控制疼痛,同时毒副作用较大的患者。按是否可以行硬膜外穿刺置管分成三组,硬膜外自控镇痛(patient controlled epidural analgesia,PCEA)组(n=28例)、静脉自控镇痛(patient controlled intravenous analgesia,PCIA)组(n=24例)和皮下自控镇痛(patient controlled skinanalgesia,PCSA)组(n=26例)。采用硬膜外自控镇痛组,镇痛液为200 ml,内含吗啡20 mg+氯胺酮100 mg。静脉和皮下自控镇痛组200 ml内含吗啡80 mg+氯胺酮400 mg。分别在安装止痛泵后24小时、48小时采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛程度,统计两组不良反应的发生率。结果:经治疗,三组病例疼痛明显缓解。三组间视觉模拟评分各时段无统计学差异(P>0.05)。吗啡和氯胺酮用量PCIA组和PCSA组明显多于PCEA组。PCEA组生活总满意度明显高于PCIA组和PCSA组。恶心呕吐、便秘、嗜睡、皮肤瘙痒、尿潴留PCIA组和PCSA组明显高于PCEA组。呼吸抑制、幻觉发生率三组无差异。结论:本研究结果表明,小剂量氯胺酮辅助吗啡硬膜外、静脉或皮下自控镇痛都可以有效治疗中/重度晚期顽固性癌痛。经硬膜外小剂量氯胺酮辅助吗啡自控镇痛具有镇痛作用强、用药量少、副作用小等优点。

CLINICAL STUDY OF MICRO-DOSAGE KETAMINE ASSOCIATED WITH MORPHINE IN PATIENT CONTROLLED ANALGESIA FOR LATE CANCER PAIN PATIENTS

Objective: To observe the analgesia effects of micro-dosage ketamine associated with morphine in patient controlled epidural analgesia(PCEA) and patient controlled intravenous analgesia(PCIA) and patient controlled skin analgesia(PCSA) for latter cancer pain patients.Methods: 78 cases latter cancer pain patients were divided into three groups,the PCEA group,the PCIA group and the PCSA group.PCEA group received morphine 40 mg and ketamine 100 mg(200 ml).PCIA and PCSA received morphine 80 mg and ketamine 400 mg(200 ml).The visual analogue scale(VAS) was used to evaluate the pain level,then the side effects rates were analysed at 24 h and 48 h after treatment.Results: Three groups patients’ pain was alleviated,and the VAS of every period showed no statistic difference(P > 0.05).The morphine and ketamine dosage in the PCIA group and PCSA group were more than that in the PCEA group.Life satisfactory rate in PCEA group was significnatly higher than that in PCIA and PCSA groups.The incidence of nausea,vomiting,indulge in sleep,skin titillation and urine retentionin in PCIA group and the PCSA group were higher than that in the PCEA group.The incidence of respiration depression and hallucination showed no significant difference between three groups.Conclusion: Low-dosage ketamin combined with morpine in PCEA,PCIA and PCSA can effectively suppress moderate to serious late-phase cancer pain.low-dosage ketamine combined with morphine in PCEA approach appears to provide patient with safe and effective pain relief and reduce side effects for moderate to serious late-phase cancer pain.