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目的评价丁丙诺啡用于晚期癌痛患者自控静脉镇痛(patient controlled intravenous anal-gesia,PCIA)的效果和安全性。方法52例癌痛患者随机分为实验组(丁丙诺啡组,n=26)和对照组(吗啡组,n=26),接受PCIA治疗。实验组使用丁丙诺啡,给药方式为持续给药0.015mg/h+PCIA给药0.015mg/次,最大用量1.08mg/24h;对照组使用吗啡,给药方式为持续给药0.5mg/h+PCIA给药0.5mg/次,最大用量36mg/24h。两组PCIA药液中均加入咪唑安定20mg。结果两组患者24h总疼痛缓解度(total painrelief,TPR)分别为18.7±6.5和21.8±7.5(P>0.05),24h总疼痛强度差(sum of pain intensity differences,SPID)分别为46.3±19.6和34.6±18.5(P<0.05)。两组患者毒副反应恶心、呕吐、头晕及嗜睡的发生率无统计学意义,分别为38%和31%(P>0.05)。结论丁丙诺啡可有效和安全地用于癌痛患者PCIA,效果与吗啡接近,与吗啡的等效剂量比为1∶46,恶心、呕吐、头晕及嗜睡毒副反应发生率接近吗啡。
Objective To evaluate the efficacy and safety of buprenorphine in patient controlled intravenous anal-gesia (PCIA). Methods 52 patients with cancer pain were randomly divided into experimental group (Buprenorphine group, n = 26) and control group (morphine group, n = 26) undergoing PCIA treatment. Buprenorphine was used in the experimental group, with continuous administration of 0.015mg / h and PCIA administration of 0.015mg / time and maximum dosage of 1.08mg / 24h. Morphine was used in the control group as continuous administration of 0.5mg / h + PCIA administration 0.5mg / time, the maximum amount of 36mg / 24h. Two groups of PCIA liquid were added midazolam 20mg. Results The total pain relief time (TPR) was 18.7 ± 6.5 and 21.8 ± 7.5 (P> 0.05), and the total pain intensity differences (SPID) at 24h were 46.3 ± 19.6 and 34.6 ± 18.5 (P <0.05). The incidence of nausea, vomiting, dizziness and drowsiness in the two groups was not statistically significant (38% vs 31%, respectively) (P> 0.05). Conclusions Buprenorphine can be effectively and safely used in PCIA of cancer pain patients. The effect is close to that of morphine. The equivalent dose ratio to morphine is 1:46. The incidence of nausea, vomiting, dizziness and narcolepsy is close to that of morphine.