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目的观察患者自控蛛网膜下腔吗啡镇痛治疗难治性癌痛的临床效果及不良反应。方法晚期癌症患者12例,在蛛网膜下腔置管,将导管埋入皮下隧道,外接PCA泵,药盒内每100 ml 生理盐水含吗啡20mg,采用首量+连续+自控模式(LCP),首剂量吗啡0.5mg,维持量吗啡20-30 μg/h, PCA为20 μg/次,锁定时间20 min。结果镇痛时间最短为10日,最长为32d,治疗前12例VAS评分均>5分,治疗后1-14d 10例疼痛完全缓解,均为0分,有2例为1-2分,14d后有9例仍为0分,吗啡平均用量为(1.3±0.5)mg/d。不良反应有恶心、呕吐、尿潴留、皮肤瘙痒,发生率以第1周多见,两周过后各种不良反应明显下降,无感染发生。结论患者自控蛛网膜下腔吗啡镇痛用于晚期癌痛治疗, 药物剂量小、镇痛效果确切,是难治性晚期癌痛WHO三阶梯药物治疗以外的一种良好的辅助及补救方法。
Objective To observe the clinical effects and adverse reactions of self-controlled subarachnoid morphine analgesia in the treatment of refractory cancer pain. Methods Twelve patients with advanced cancer were treated with subarachnoid catheterization. The catheter was embedded in a subcutaneous tunnel and an external PCA pump was used. The capsule contained 20 mg of morphine per 100 ml of saline, and the first dose + continuous + automatic control mode (LCP) The first dose of morphine 0.5mg, maintaining the amount of morphine 20-30 μg / h, PCA was 20 μg / time, locking time 20 min. Results The shortest analgesic time was 10 days and the longest was 32 days. The VAS score of the 12 patients before treatment was> 5 points and the pain was completely relieved in 10 cases 1 ~ After 14 days, 9 cases were still 0 points, the average amount of morphine was (1.3 ± 0.5) mg / d. Adverse reactions were nausea, vomiting, urinary retention, skin itching, the incidence of more common in the first week, two weeks after the various adverse reactions decreased significantly, no infection occurred. Conclusions Patients with subarachnoid morphine analgesia for the treatment of advanced cancer pain, small dose, analgesic effect is exact, is refractory advanced cancer pain in addition to the WHO three-step ladder a good adjuvant and remedy.