摘要
目的 探讨右美托咪啶复合吗啡静脉自控镇痛对晚期癌痛患者生存质量的临床观察。方法 选取2019年9月至2022年8月期间在我院肿瘤科晚期癌痛患者52例，随机数字表法将患者分为观察组（n=26）和对照组（n=26）。对照组给予吗啡PCIA镇痛，观察组采用右美托咪定复合吗啡PCIA镇痛。比较两组患者PCIA镇痛前后NRS评分、PSQI评分、HAMA评分、HAMD评分、PCA 总按压次数、不良反应发生情况。结果 PCIA后两组患者NRS、PSQI、HAMA 、HAMD 评分均显著低于PCIA前，观察组优于对照组（P < 0.05）。PCIA后观察组患者PCA 总按压次数低于对照组（P < 0.05）。PCIA后对照组不良反应发生率（53.85%）高于观察组（23.07%），差异有统计学意义（P < 0.05）。结论 右美托咪啶复合吗啡PCIA可提高晚期癌痛患者的镇痛效果，减少吗啡用药量，不良反应发生率低，患者及家属满意度增加，同时改善患者的生存质量。
关键词： 右美托咪啶；吗啡；静脉自控镇痛；癌痛
Abstract
Objective To investigate the effect of dexmedetomidine combined with morphine on quality of life in patients with advanced cancer pain. Methods Fifty-two patients with advanced cancer pain admitted to the Department of Oncology of our hospital from September 2019 to August 2022 were selected and divided into observation group (n=26) and control group (n=26) by random number table. The control group was given morphine PCIA analgesia, and the observation group was given dexmedetomidine combined with morphine PCIA analgesia. NRS scores, PSQI scores, HAMA scores, HAMD scores, total compressions of PCA and the incidence of adverse reactions were compared between the two groups before and after PCIA analgesia. Results After PCIA, NRS, PSQI, HAMA and HAMD scores in two groups were significantly lower than those before PCIA, and observation group was better than control group (P < 0.05). The total number of PCA compressions in the observation group after PCIA was lower than that in the control group (P < 0.05). After PCIA, the incidence of adverse reactions in control group (53.85%) was higher than that in observation group (23.07%). Conclusion Dexmedetomidine combined with morphine PCIA can improve the analgesic effect of patients with advanced cancer pain, reduce the dosage of morphine, reduce the incidence of adverse reactions, increase the satisfaction of patients and their families, and improve the quality of life of patients.
Key words： Dexmedetomidine; Morphine; Intravenous controlled analgesia; Cancer pain
参考文献 References
[1] Rodriguez C, Ji M, Wang H L, et al. Cancer Pain and Quality of Life [J]. Hosp Palliat Nurs, 2019, 21(2): 116-123.
[2] 成禹,吴晓智,陈国忠.右美托咪定对晚期癌痛患者镇静及镇痛的影响[J].实用疼痛学杂志,2016,12(05):350-353.
[3] 张运宏,林鹏,李刚,等.右美托咪定自控镇痛对卵巢癌病人镇痛效应和免疫功能的影响[J].中国疼痛医学杂志,2021,27(04):312-316.
[4] Wirz S, Seidensticker S, Shtrichman R. Patient-Controlled Analgesia (PCA): Intravenous Administration (IV-PCA) versus Oral Administration (Oral-PCA) by Using a Novel Device (PCoA® Acute) for Hospitalized Patients with Acute Postoperative Pain-A Comparative Retrospective Study[J]. Pain Res Manag. 2021;2021:2542010.
[5] Rojas-Corrales M O, E B errocoso, Gibert-Rahola J, et al. Antidepressant-like effects of tramadol and other central analgesics with activity on monoamines reuptake, in helpless rats[J].Life Sciences, 2002, 72(2):143-152.
[6] Lutz P E , Kieffer B L. Opioid receptors: Distinct roles in mood disorders[J]. Trends Neurosci, 2013, 36(3):195-206.
[7] Guangming, Yan, Jie, et al. Effects of patient-controlled analgesia with hydromorphone or sufentanil on postoperative pulmonary complications in patients undergoing thoracic surgery: a quasi-experimental study[J]. Bmc Anesthesiology, 2018,18(1):37.
[8] Fairbanks C A et al. Moxonidine, a selective imidazoline-alpha2 -adrenergic receptor agonist, produces spinal synergistic antihyperalgesia with morphine in nerve-injured mice[J]. Anesthesiology, 2000, 93(3) : 765-73.
[9] Zhang P, Bu J, Wu X, et al. Upregulation of μ-Opioid Receptor in the Rat Spinal Cord Contributes to the α2-Adrenoceptor Agonist Dexmedetomidine-Induced Attenuation of Chronic Morphine Tolerance in Cancer Pain[J]. J Pain Res. 2020 ,15(13):2617-2627.
[10] Wang X , Loram L C , Ramos K , et al. Morphine activates neuroinflammation in a manner parallel to endotoxin[J]. Proc Natl Acad Sci U S A, 2012, 109(16):6325-6330.
[11] Eidson L N , Murphy A Z . Blockade of Toll-Like Receptor 4 Attenuates Morphine Tolerance and Facilitates the Pain Relieving Properties of Morphine[J]. J Neurosci, 2013, 33(40):15952-15963.
[12] Ji Dong, et al. Anti-nociceptive effect of dexmedetomidine in a rat model of monoarthritis via suppression of the TLR4/NF-κB p65 pathway[J]. Exp Ther Med, 2017, 14(5) : 4910-4918.
[13] Li HJ, Li CJ, Wei XN, et al. Dexmedetomidine in combination with morphine improves postoperative analgesia and sleep quality in elderly patients after open abdominal surgery: A pilot randomized control trial[J]. PLoS One. 2018,13(8):e0202008.
[14] Tang C , Xia Z . Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic[J]. J PAIN RES, 2017, 10:1899-1904.
[15] Lee S . Dexmedetomidine: Present and future directions[J]. Korean J Anesthesiol, 2019, 72(4):323-330.
[16] 陈浩飞, 田蜜, 朱红梅,等.吗啡联合右美托咪定静脉自控镇痛用于难治性癌痛的临床研究[J].中国疼痛医学杂志, 2019, 25(04):52-58+63.