中国临床药学杂志

目的观察间断鞘内注射小剂量罗哌卡因复合吗啡治疗腹部晚期癌痛患者的临床效果。方法选择26例腹部晚期癌痛患者植入鞘内输注系统并置导管头端于T8~T10水平,术后分为2个阶段:第一阶段鞘内单纯吗啡(M阶段);第二阶段罗哌卡因联合吗啡(M+R阶段)。采用前瞻、交叉和双盲法,所有患者随机分配到M阶段和M+R阶段,待获得72 h满意的镇痛后交叉进行另一阶段鞘内注射。记录治疗阶段的疼痛评分、满意度、有效吗啡剂量,以及生活质量评分;观察治疗阶段的生命体征变化和主要不良反应。结果 3个阶段的生命体征之间差异无统计学意义。与M阶段相比,M+R阶段的疼痛评分、生活质量评分和满意度评分相当,差异无统计学意义,但M+R吗啡日用剂量降低了约30%(P<0.01)。M+R阶段的罗哌卡因最后一日用量为(3.8±0.9)mg。M和M+R阶段的主要不良反应发生率之间未见明显差异。结论鞘内间断注射小剂量罗哌卡因复合吗啡可减少腹部晚期癌痛患者的吗啡用量,不增加不良反应的发生。

AIM To observe clinical effects of low dose ropivacaine combined with morphine intermittent intrathecal injection on patients with terminal cancer pain of abdomen. METHODS Twenty-six patients with terminal cancer pain of abdomen were implanted drug delivery system and catheter tip was located to T8- T10. After implantation,patients were taken a two-phase protocol and taken a double-blind,perspective,crossover trial. Phase M( morphine) and M + R( morphine + ropivacaine) were respectively given morphine and mixture of ropivacaine and morphine. Injectants of two phases were given by multiple injection until satisfactory pain relief and lasted 72 h. Pain intensity,dose of morphine,treatment satisfaction and quality of life were evaluated. The main adverse drug reactions were carefully observed and recorded by physicians. RESULTS No statistical significances were found in changes of vital sign in three phases. Treatment satisfaction and quality of life were no significant differences between phase M and phase M + R. But the effective dosage of morphine was significantly reduced at phase M + R( P < 0. 05). The incidences of adverse drug reactions were no significant differences between phase M and phase M + R. In phase M + R,the dosage of intrathecal ropivacaine was( 3. 8 ± 0. 9) mg. CONCLUSION For patients with terminal cancer pain of abdomen,low dose ropivacaine combined with morphine intermittent intrathecal injection can reduce the dosage of morphine,and not increase the incidence of adverse drug reactions.