CAJ | 학술논문

目的探讨右美托咪啶复合吗啡对顽固性癌痛患者静脉自控镇痛(PCIA)效果的影响.方法选择顽固性癌痛患者40例,按随机数字表法分为试验组和对照组,每组20例.试验组药物组成:吗啡200 mg+右美托咪啶1.0 mg+昂丹司琼16 mg+ 0.9％氯化钠.对照组药物组成:吗啡200 mg+昂丹司琼16 mg+ 0.9％氯化钠.两组镇痛液容量均为200 ml.试验组静脉缓慢泵注(10 min)负荷剂量右美托咪啶0.5μg/kg后开始PCIA,对照组泵注同样体积的0.9％氯化钠后开始PCIA.记录两组给药前2h和给药后2,4,8,16,32和48 h的视觉模拟量表(VAS)评分,给药后各时间点Ramsay镇静评分,给药后48 h内自控镇痛泵按压次数及吗啡总消耗量、不良反应(低血压、心动过缓、呼吸抑制、恶心呕吐)发生情况.结果与给药前2h比较,两组给药后各时间点VAS评分明显降低,差异有统计学意义(P＜0.01).试验组给药后各时间点Ramsay镇静评分显著高于对照组,48 h内自控镇痛泵按压次数明显低于对照组[(4.5±2.2)次比(18.4±5.4)次],吗啡总消耗量明显少于对照组[(90.8 ±7.2) mg比(100.5±10.5) mg],恶心呕吐发生率明显低于对照组,差异有统计学意义(P＜0.01),两组呼吸抑制和低血压的发生率比较差异无统计学意义(P＞0.05).结论右美托咪啶复合吗啡用于顽固性癌痛患者可增强镇痛效果和镇静效果,降低吗啡使用剂量.
목적 탐토우미탁미정복합마배대완고성암통환자정맥자공진통(PCIA)효과적영향.방법 선택완고성암통환자40례,안수궤수자표법분위시험조화대조조,매조20례.시험조약물조성:마배200 mg+우미탁미정1.0 mg+앙단사경16 mg+ 0.9％록화납.대조조약물조성:마배200 mg+앙단사경16 mg+ 0.9％록화납.량조진통액용량균위200 ml.시험조정맥완만빙주(10 min)부하제량우미탁미정0.5μg/kg후개시PCIA,대조조빙주동양체적적0.9％록화납후개시PCIA.기록량조급약전2h화급약후2,4,8,16,32화48 h적시각모의량표(VAS)평분,급약후각시간점Ramsay진정평분,급약후48 h내자공진통빙안압차수급마배총소모량、불량반응(저혈압、심동과완、호흡억제、악심구토)발생정황.결과 여급약전2h비교,량조급약후각시간점VAS평분명현강저,차이유통계학의의(P＜0.01).시험조급약후각시간점Ramsay진정평분현저고우대조조,48 h내자공진통빙안압차수명현저우대조조[(4.5±2.2)차비(18.4±5.4)차],마배총소모량명현소우대조조[(90.8 ±7.2) mg비(100.5±10.5) mg],악심구토발생솔명현저우대조조,차이유통계학의의(P＜0.01),량조호흡억제화저혈압적발생솔비교차이무통계학의의(P＞0.05).결론 우미탁미정복합마배용우완고성암통환자가증강진통효과화진정효과,강저마배사용제량.
Objective To explore the effect of dexmedetomidine combined with morphine in intractable cancer pain with patient-controlled intravenous analgesia (PCIA).Methods Forty patients with intractable cancer pain were divided into experiment group and control group by random digits table method with 40 cases each.Composition of experiment group:morphine 200 mg + dexmedetomidine 1.0 mg + ondansetron 16 mg + 0.9％ sodium chloride.Composition of control group:morphine 200 mg+ ondansetron 16 mg + 0.9％ sodium chloride.Both analgesic fluid volume were 200 ml.The patients in experiment group were administrated 10 min with 0.5 μg/kg dexmedetomidine then received PCIA,the patients in control group were administrated 10 rmin with equal 0.9％ sodium chloride then received PCIA.The visual analogue scale (VAS) score was recorded 2 h before administration and 2,4,8,16,32,48 h after administration.Ramsay sedation score was recorded at all the time points after administration.The press number of patient-controlled analgesia pump and dosage of morphine in 48 h after administration,incidence of side effects (low pressure,bradycardia,respiratory inhibition,nausea and vomiting) were recorded.Results Compared with 2 h before administration,the VAS score was significantly lower at every time point after administration in the 2 groups,there was statistical difference (P ＜ 0.01).The Ramsay sedation score at every time point after administration in experiment group was significantly higher than that in control group,the press number of patient-controlled analgesia pump in 48 h was significantly lower than that in control group [(4.5 ± 2.2) times vs.(18.4 ± 5.4) times],dosage of morphine was significantly lower than that in control group [(90.8 ±7.2) mg vs.(100.5 ± 10.5) mg,the incidence of nausea and vomiting was significantly lower than that in control group,there were statistical differences (P ＜ 0.01).However,there were no significant differences in the incidence of respiratory depression and low pressure between the 2 groups (P ＞ 0.05).Conclusion Dexmedetomidine combined with morphine in the treatment of intractable cancer pain can effectively improve the analgesic effect and sedative effect,reduce the dosage of morphine.