鞘内注射右美托咪定联合吗啡对晚期癌症患者癌性疼痛及血清炎性因子的影响
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摘要
目的探讨鞘内注射右美托咪定联合吗啡对晚期癌症患者癌性疼痛及血清炎性因子的影响。方法选择96例拟行鞘内镇痛的晚期癌症患者,采用随机数字表法随机分为对照组48例和观察组48例。对照组患者给予鞘内注射吗啡镇痛,观察组患者给予鞘内注射右美托咪定联合吗啡镇痛。比较两组患者的吗啡使用量、镇痛效果、血清炎性因子水平及不良反应的发生率等。结果鞘内镇痛后7天,观察组患者的吗啡使用量明显少于对照组(P﹤0.01),视觉模拟疼痛评分(VAS)明显低于对照组(P﹤0.01),满意度评分、Spitzer生活质量指数(SQLI)评分均明显高于对照组(P﹤0.01);鞘内镇痛后7天,观察组患者的血清白细胞介素-6(IL-6)、C反应蛋白(CRP)水平均明显低于对照组(P﹤0.01),皮质醇(Cor)水平明显高于对照组(P﹤0.01);治疗期间,观察组患者的恶心呕吐、瘙痒的发生率均低于对照组(P﹤0.05),嗜睡的发生率明显高于对照组(P﹤0.01)。结论鞘内注射右美托咪定有助于减少晚期癌症患者的吗啡使用量,缓解癌性疼痛,可能与其可抑制患者的炎性反应状态有关。
Objective To investigate the effect of combined intrathecal dexmedetomidine and morphine injection on serum inflammatory factors and cancerous pain in patients with advanced cancer. Method A total of 96 patients with advanced cancer underwent intrathecal analgesia were selected and randomly divided into the observation group and control group by random number table, with 48 cases in each group. The control group was administered intrathecal morphine injection and the observation group intrathecal dexmedetomidine and morphine injection for analgesia. The dosage of morphine, analgesic effect, serum inflammatory factors and rates of adverse reactions were compared. Result 7 days after intrathecal analgesia, the dosage of morphine in the observation group was significantly less than that of the control group(P<0.01), the visual analogue scale(VAS) significantly lower, the scores of satisfaction and Spitzer quality of life index(SQLI) significantly higher than those of control group(P<0.01). The levels of serum interleukin-6(IL-6), C-reactive protein(CRP) were significantly lower, and the levels of cortisol(Cor) significantly higher than those of the control group(P<0.01). During the treatment, the incidences of nausea, vomiting and itching of the observation group were significantly lower(P<0.05), and the incidence of drowsiness higher(P<0.01) than those of the control group. Conclusion Intrathecal dexmedetomidine injection can reduce the dosage of morphine and alleviate cancerous pain in patients with advanced cancer, which may be related to inhibition of inflammatory status of patients.
Objective To investigate the effect of combined intrathecal dexmedetomidine and morphine injection on serum inflammatory factors and cancerous pain in patients with advanced cancer. Method A total of 96 patients with advanced cancer underwent intrathecal analgesia were selected and randomly divided into the observation group and control group by random number table, with 48 cases in each group. The control group was administered intrathecal morphine injection and the observation group intrathecal dexmedetomidine and morphine injection for analgesia. The dosage of morphine, analgesic effect, serum inflammatory factors and rates of adverse reactions were compared. Result 7 days after intrathecal analgesia, the dosage of morphine in the observation group was significantly less than that of the control group(P<0.01), the visual analogue scale(VAS) significantly lower, the scores of satisfaction and Spitzer quality of life index(SQLI) significantly higher than those of control group(P<0.01). The levels of serum interleukin-6(IL-6), C-reactive protein(CRP) were significantly lower, and the levels of cortisol(Cor) significantly higher than those of the control group(P<0.01). During the treatment, the incidences of nausea, vomiting and itching of the observation group were significantly lower(P<0.05), and the incidence of drowsiness higher(P<0.01) than those of the control group. Conclusion Intrathecal dexmedetomidine injection can reduce the dosage of morphine and alleviate cancerous pain in patients with advanced cancer, which may be related to inhibition of inflammatory status of patients.
引文
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[14]张粒子,张婧,徐世元.鞘内注射右美托咪定对瑞芬太尼诱发的大鼠术后痛觉过敏的影响[J].实用药物与临床,2014,17(11):1384-1388.
[15]刘涛.鞘内注射右美托咪定联合吗啡对晚期恶性肿瘤患者镇痛的效果[J].实用癌症杂志,2015,30(12):1934-1937.
[16]王玉栋,陈红姗,单玉洁,等.晚期肺癌患者癌症相关性疲乏的发生与血清炎性因子的关系[J].肿瘤防治杂志,2015,42(6):576-581.
[17]Ji YB,Bo CL,Xue XJ,et al.Association of inflammatory cytokines with the symptom cluster of pain,fatigue,depression,and sleep disturbance in Chinese patients with cancer[J].J Pain Symptom Manage,2017,54(6):843-852.
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[19]林豫蓉.肺癌患者癌因性疲乏与血清CRP、IL-6、ACTH、皮质醇的关系研究[J].临床肺科杂志,2018,23(1):146-149.
[20]巩红岩,郑芳,左志超,等.鞘内注射右美托咪定对大鼠吗啡耐受及脊髓炎性反应的影响[J].重庆医学,2017,46(34):4771-4773.
[21]邓爱琴,邓智连,徐林,等.不同剂量右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子的影响[J].广东医学,2016,37(10):1549-1551.
[2]El Aish KA,Tafish R,Zourob H.Morphine versus fentanyl for spinal post-caesarean analgesia:a randomised controlled trial[J].Lancet,2018,391(Suppl 2):S20.
[3]高慧,姬乐,王敏,等.右美托咪定对胃癌手术患者免疫状况的影响[J].癌症进展,2016,14(8):774-776;779.
[4]刘红军,高献忠,李伟彦,等.鞘内注射右旋美托咪定对晚期癌痛患者行吗啡鞘内镇痛的影响[J].中国疼痛学杂志,2014,20(6):412-415;420.
[5]张金强,张杰,陈军,等.右美托咪定复合微量吗啡鞘内输注在无痛分娩中的应用分析研究[J].中国全科医学2017,20(B12):167-169.
[6]宗行万之助.疼痛的估价--用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994,2(4):153.
[7]崔绪芳,马兴燕,艾爽,等.患者自控静脉镇痛与硬膜外镇痛满意度的调查分析[J].实用疼痛学杂志,2011,7(6):442-444.
[8]Beaulieu S,Wood-Dauphinee S,Abrahamowicz M,et al.Alow back pain module for use with the Spitzer quality of life index[J].Qual Life Res,1995,4(5):396.
[9]Deer T,Krames ES,Hassenbusch SJ,et al.Polyanalgesic consensus conference 2007:recommendations for the management of pain by intrathecal(intraspinal)drug delivery:report of an interdisciplinary expert panel[J].Neuromodulation,2007,10(4):300-328.
[10]马振晓,何淑芳,邹桂昌,等.吗啡预处理对NGF诱导神经细胞TRPV1通道敏化及ERK蛋白活化的影响[J].中国药理学通报,2018,34(5):675-680.
[11]Abdel-Ghaffar HS,Mohamed SA,Fares KM,et al.Combined intrathecal morphine and dexmedetomidine for postoperative analgesia in patients undergoing major abdominal cancer surgery[J].Pain Med,2016,17(11):2109-2118.
[12]邓海洪,马松梅,肖晓山.鞘内注射右美托咪定干预慢性神经痛模型大鼠脊髓背角蛋白激酶C的表达[J].中国组织工程研究,2014,18(29):4683-4688.
[13]孙虎,张亮,徐志新.右美托咪定鞘内注射对慢性神经痛模型大鼠行为能力、疼痛程度和脊髓背角蛋白激酶C表达的影响[J].中国比较医学杂志,2017,27(6):6-11;32.
[14]张粒子,张婧,徐世元.鞘内注射右美托咪定对瑞芬太尼诱发的大鼠术后痛觉过敏的影响[J].实用药物与临床,2014,17(11):1384-1388.
[15]刘涛.鞘内注射右美托咪定联合吗啡对晚期恶性肿瘤患者镇痛的效果[J].实用癌症杂志,2015,30(12):1934-1937.
[16]王玉栋,陈红姗,单玉洁,等.晚期肺癌患者癌症相关性疲乏的发生与血清炎性因子的关系[J].肿瘤防治杂志,2015,42(6):576-581.
[17]Ji YB,Bo CL,Xue XJ,et al.Association of inflammatory cytokines with the symptom cluster of pain,fatigue,depression,and sleep disturbance in Chinese patients with cancer[J].J Pain Symptom Manage,2017,54(6):843-852.
[18]Vachon-Presseau E,Roy M,Martel MO,et al.The stress model of chronic pain:evidence from basal cortisol and hippocampal structure and function in humans[J].Brain,2013,136(Pt 3):815-827.
[19]林豫蓉.肺癌患者癌因性疲乏与血清CRP、IL-6、ACTH、皮质醇的关系研究[J].临床肺科杂志,2018,23(1):146-149.
[20]巩红岩,郑芳,左志超,等.鞘内注射右美托咪定对大鼠吗啡耐受及脊髓炎性反应的影响[J].重庆医学,2017,46(34):4771-4773.
[21]邓爱琴,邓智连,徐林,等.不同剂量右美托咪定对腹腔镜下子宫恶性肿瘤手术患者炎症因子的影响[J].广东医学,2016,37(10):1549-1551.