鹽酸右美托咪定連續(xù)靜脈泵入聯(lián)合羅哌卡因治療頑固性晚期癌痛的療效觀察

石君

摘 要 目的：探討鹽酸右美托咪定連續(xù)靜脈泵入聯(lián)合羅哌卡因治療頑固性晚期癌痛的療效。方法：將98例頑固性晚期癌痛患者按照數(shù)字隨機(jī)法隨機(jī)分為觀察組和對(duì)照組各49例，觀察組選用鹽酸右美托咪定連續(xù)靜脈泵入聯(lián)合羅哌卡因鎮(zhèn)痛，對(duì)照組選用單純鹽酸右美托咪定連續(xù)靜脈泵入鎮(zhèn)痛，采用視覺模擬評(píng)分法（VAS） 評(píng)估患者在給藥后的鎮(zhèn)痛效果及滿意度，并觀察不良反應(yīng)發(fā)生情況。結(jié)果：用藥后，觀察組VAS評(píng)分明顯低于對(duì)照組（ P<0.05）；觀察組和對(duì)照組不良反應(yīng)發(fā)生率分別為6.12%和8.16%（P>0.05）；觀察組患者滿意度為91.84%，明顯高于對(duì)照組的81.63% （ P<0.05）。結(jié)論：鹽酸右美托咪定連續(xù)靜脈泵入聯(lián)合羅哌卡因?qū)︻B固性晚期癌痛患者的鎮(zhèn)痛效果顯著，患者滿意度高，值得臨床推廣。

關(guān)鍵詞 鹽酸右美托咪定 羅哌卡因 晚期癌痛

中圖分類號(hào)：R971.3； R473.73 文獻(xiàn)標(biāo)識(shí)碼：B 文章編號(hào)：1006-1533（2014）21-0037-03

Observation of the curative effect of the continuous intravenous pumping

of dexmedetomidine hydrochloride combined with ropivacaine

for the treatment of intractable advanced cancer pain*

SHI Jun

（Department of Oncology， Shanggao Peoples hospital of Yichun City， Yichun 336000， China）

ABSTRACT Objective： To explore the effect of the continuous intravenous pumping of dexmedetomidine hydrochloride combined with ropivacaine for the treatment of intractable advanced cancer pain. Methods： Ninety-eight cases of patients with intractable advanced cancer were randomly divided into an observation group and a control group with 49 cases each. The continuous intravenous pumping of dexmedetomidine hydrochloride combined with ropivacaine was given for analgesia in the observation group while only the continuous intravenous pumping of dexmedetomidine hydrochloride in the control group. Analgesia effect and satisfaction were evaluated by using a visual analog scale （VAS） after administration and the incidence of adverse reactions was also observed. Results： The VAS scores were significantly lower in the observation group than in the control group after treatment （P<0.05）. The incidence of adverse reactions was 6.12% in the observation group and 8.16% in the control group （P>0.05）. The satisfaction of patients was 91.84% in the observation group， which was significantly higher than 81.63% in the control group （P<0.05）. Conclusion： The combination therapy has a significant analgesic effect with higher patient satisfaction and worthy of clinical promotion.

KEY WORDS dexmedetomidine hydrochloride； ropivacaine； advanced cancer

癌性疼痛是疼痛部位需要修復(fù)或調(diào)節(jié)的信息傳遞到神經(jīng)中樞后引起的感覺，也稱為癌痛。對(duì)于晚期癌痛患者，疼痛往往成為其生命最后階段最為痛苦的經(jīng)歷，臨床上口服或靜脈注射阿片類藥物是緩解疼痛的主要方法，但因不良反應(yīng)多，故有效的鎮(zhèn)痛治療已成為目前亟待解決的問(wèn)題[1]。筆者對(duì)本院98例頑固性晚期癌痛患者的治療療效進(jìn)行觀察，旨在探索對(duì)頑固性晚期癌痛有效治療的新方法，現(xiàn)報(bào)道如下。

資料與方法

一般資料

入選2011年4月-2013年4月在本院就診的98例頑固性晚期癌痛患者，按照數(shù)字隨機(jī)法隨機(jī)分為觀察組和對(duì)照組各49例。納入標(biāo)準(zhǔn)：① 經(jīng)病理或細(xì)胞學(xué)確診為晚期惡性腫瘤，預(yù)計(jì)生存期半年以上；② 無(wú)放化療指征；③按照WHO推薦的三階梯止痛法治療無(wú)效；④對(duì)右美托咪定和羅哌卡因不過(guò)敏。排除標(biāo)準(zhǔn)：①伴有其他心、肝、腎等重要臟器嚴(yán)重性疾病；② 有精神病病史；③中途中止或拒絕參與本次試驗(yàn)。觀察組中男31例，女18例，年齡34～78歲，平均年齡（54. 27±9.25）歲，其中肺癌10例，肝癌6例，腸癌11例，胃癌9例，乳腺癌9例，其他4例，視覺模擬評(píng)分法（VAS）疼痛評(píng)分為（9.13±1.27）分；對(duì)照組中男30例，女19例，年齡36～77歲，平均年齡（54.31±9.19）歲，其中肺癌11例，肝癌8例，腸癌10例，胃癌10例，乳腺癌7例，其他3例，VAS疼痛評(píng)分為（9.14±1.22）分。兩組患者在性別、年齡、癌癥類型、疼痛程度上比較無(wú)顯著差異（P>0.05），具有可比性。所有患者均同意接受試驗(yàn)，簽署知情同意書。