小剂量氯胺酮辅助芬太尼静脉自控镇痛用于晚期癌痛治疗

目的观察小剂量氯胺酮辅助芬太尼静脉自控镇痛(PCIA)用于晚期癌痛患者的止痛效果。方法选择49例中、重度晚期癌痛病人,随机分成两组,均以镇痛泵(1 ml/h)行静脉镇痛,Ⅰ组采用芬太尼0.3μg/(kg.h),Ⅱ组用芬太尼0.2μg/(kg.h)+氯胺酮70μg/(kg.h)。每种配方中均加入恩丹西酮(枢丹)16 mg、氟哌啶10 mg,并用生理盐水将混合药液稀释至100 ml。分别在安装止痛泵后2、24、48 h采用视觉模拟评分法(VAS)评估疼痛程度,统计两组不良反应的发生率。结果经治疗,两组病例疼痛基本缓解。Ⅱ组的疼痛评分在各时间点均明显低于Ⅰ组(P<0.01),而PCIA按压次数和芬太尼用量明显少于Ⅰ组,恶心呕吐、便秘等副反应Ⅰ组明显高于Ⅱ组,皮肤瘙痒、呼吸抑制、幻觉发生率两组无统计学差异。Ⅱ组生活总满意度明显高于Ⅰ组。结论小剂量氯胺酮辅助芬太尼静脉自控镇痛用于晚期癌痛,镇痛效果好,副作用小。

PCIA with low dose Ketamine combined with Fentanyl for treatment of terminal cancer pain

Objective To observe the analgesic effect of patient control intravenous analgesia(PCIA) with low-dose Ketamine and Fentanyl for terminal cancer pain patients.Methods 49 patients with moderate to severe terminal cancer pain were randomly divided into two groups.They were treated with Fentanyl 0.3 μg/(kg·h)(groupⅠ) orFentanyl 0.2 μg/(kg·h)+Ketamine 70 μg/(kg·h)(groupⅡ).Ondansetron(Zudan) 16 mg and Droperidol 10mg were added into each treatment.The mixed liquid was diluted to 100ml with physiological saline.The visual analogue scale(VAS) of pain scores and the rate of side effects were evaluated at 2,24 and 48h after analgesic pump was used.Results The degrees of pain in both groups were largely alleviated.Compared with groupⅠ,the pain score of groupⅡ at each time point was significantly lower(P< 0.01),and the times of pressing of PCIA and dosage of Fentanyl in groupⅡ were less(P<0.01).The incidences of nausea,vomiting and constipation in groupⅠwere higher than those in group Ⅱ.There was no difference in the incidences of skin itch,respiration depression and hallucination between two groups.The patients’ life satisfactory rate in group Ⅱ was obviously higher than that in group Ⅰ.Conclusion PCIA with low-dose Ketamine and Fentanyl for terminal cancer pain patients has the good analgesic effect and fewer side effects.