硬膜外注射与鞘内注射吗啡治疗老年晚期癌症重度癌性疼痛的临床疗效及对生活质量评分的影响

发布时间：2018-06-13 23:06

本文选题：晚期癌症 + 癌性疼痛　；参考：《中国老年学杂志》2017年24期

【摘要】：目的研究老年晚期癌症重度癌性疼痛治疗中硬膜外注射与鞘内注射吗啡对临床疗效及生活质量评分的影响。方法选取晚期癌症重度癌性疼痛患者48例,根据患者意愿分为硬膜外组(n=27)和鞘内注射组(n=21)。硬膜外组采用硬膜外注射吗啡镇痛治疗,鞘内注射组采用鞘内注射吗啡镇痛治疗。对比两组患者镇痛前后每日吗啡的平均用量、生活质量评分(QLQ-C30)、疼痛评估视觉模拟评分(VAS)、细胞免疫功能和安全性。结果硬膜外组患者每日吗啡用量于镇痛后1 w、2 w及1个月时较鞘内注射组高(P0.05),且两组患者镇痛后各时点的每日吗啡平均用量均较各自镇痛前低(P0.05)。硬膜外组患者QLQ-C30评分于镇痛后1 w、2 w及1个月时较鞘内注射组低(P0.05),且两组患者镇痛后各时点的QLQ-C30评分均较各自镇痛前高(P0.05)。硬膜外组患者运动及静息状态下VAS于镇痛后1 w、2 w及1个月时较鞘内注射组高(P0.05),且两组患者镇痛后各时点的运动及静息状态下VAS均较各自镇痛前低(P0.05)。鞘内注射组患者镇痛后1个月CD3~+、CD4~+、CD4~+/CD8~+水平较硬膜外组均明显升高(P0.05)。镇痛后1个月CD8~+水平两组对比无显著差异(P0.05),且两组患者镇痛后1 w、1个月的CD3~+、CD4~+水平与镇痛前对比均有统计学差异,而两组患者镇痛后1 w的CD8~+、CD4~+/CD8~+水平与镇痛前对比无显著差异(P0.05),镇痛后1个月与镇痛前对比有显著差异(P0.05)。两组患者均有并发症发生,硬膜外组并发症发生率为59.26%明显高于鞘内注射组19.05%(P0.05)。结论对于晚期癌症重度癌性疼痛患者的疼痛可通过单纯持续鞘内注射吗啡有效缓解,鞘内应用吗啡用量更小。
[Abstract]:Objective to study the effect of epidural and intrathecal morphine injection on clinical efficacy and quality of life score in the treatment of severe cancer pain in the elderly. Methods 48 patients with advanced cancer with severe cancer pain were divided into epidural group (n = 27) and intrathecal injection group (n = 21). The epidural group received epidural morphine analgesia, and the intrathecal injection group received intrathecal morphine analgesia. Before and after analgesia, the average dose of morphine, the quality of life score (QLQ-C30), visual analogue score (VASA), cellular immune function and safety were compared between the two groups. Results the daily dose of morphine in the epidural group was higher than that in the intrathecal injection group at 2 weeks and 1 month after analgesia, and the daily average dose of morphine at each time point after analgesia in both groups was lower than that before analgesia. The QLQ-C30 score in epidural group was lower than that in intrathecal injection group at 2 weeks and 1 month after analgesia, and the QLQ-C30 score in both groups was higher than that before analgesia. The VAS in the epidural group was significantly higher than that in the intrathecal injection group at 2 weeks and 1 month after analgesia, and the exercise at each time point after analgesia and the VAS in resting state were lower than those before analgesia. In the intrathecal injection group, the level of CD3 ~ + CD4 ~ + CD4 ~ / CD8 ~ + was significantly higher than that in the epidural group at 1 month after analgesia. There was no significant difference in the level of CD8 ~ between the two groups at 1 month after analgesia, and there was statistical difference between the two groups in the level of CD3 ~ + CD4 ~ at 1 week after analgesia and before analgesia. However, there was no significant difference between the two groups in the level of CD8 ~ + CD4 ~ / CD8~ + and before analgesia 1 week after analgesia, but there was a significant difference between the two groups at 1 month after analgesia and before analgesia (P 0.05). The incidence of complications in epidural group (59.26%) was significantly higher than that in intrathecal injection group (19.05) (P 0.05). Conclusion the pain in patients with advanced cancer and severe cancer pain can be effectively alleviated by continuous intrathecal injection of morphine, and the dosage of intrathecal morphine is much smaller.
【作者单位】：重庆市肿瘤研究所;遵义市第一人民医院;
【基金】：重庆市卫生和计生委科研基金资助(2017jstg07)
【分类号】：R730.5

【相似文献】