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1、病人自控蛛网膜下腔吗啡镇痛治疗难治性晚期癌痛程平瑞1孙来保2曹小龙:'江伟航1黄政通1董静毅1［摘要］目的观察病人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，采用贝朗公司的Spinocath蛛网膜下腔置管套装，将导管埋入皮下隧道，外接韩国奥美2400型PCA泵，药盒内每100ml生理盐水含20mg吗啡，采用首量+连续+自控模式(LCP),首剂量0.5mg吗啡，维持量吗啡20〜30ug/h,PCA为20ug/次，锁定时间20mino记录治疗前、后每天疼痛程度VAS评分、吗啡用量；观察每天血压、
2、心率、呼吸频率及不良反应。结果镇痛吋间最短为10天，最长为32天，治疗前12例病人VAS评分均＞5分，治疗后1〜14天10例病人完全缓解，均为0分，有2例为1〜2分，14天后有9例病人仍为0分，吗啡平均用量为1.3+0.5mg/do不良反应有恶心、呕吐、尿潴留、皮肤搔痒，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。结论病人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WII0三阶梯药物治疗以外的一种良好的辅助及补救方法。［关键词］吗啡；蛛网膜下腔；疼痛；肿瘤1.广州市番禺区人
3、民医院麻醉科，3.本院肿瘤科2.中山大学附属第一医院麻醉科*基金项目：广州市番禺区科技局资助(2001—Z-28-1)Efficacyofintrathecalmorphinebypation-controlledanalgesiaforthepatientwithintractablecancerpainChengpingrui,Sunlaibao,Chaoxiaolong,etal.Departmentofanesthesiology,GuangzhouPanyuPeople'sHospital,Dpartmentofane
4、sthesiology,thefirstAffiliatedHospitalofSun-yatSenUniversity,Depai'tmentofOncology,GuangzhouPanyuPeople?sHospital.[Abstract]ObjectiveTOobservetheefficacyofintrathecalwithcancerpain・Methods12patientswithcancerpainwereincludedinthestudy.Thecatheterwasplacedinintratheca
5、l,andconnectedwith,aPCApump.LCPmodewasadopted.Loadingdoseofmorphinewas0.5mg.Backgrounddosefrom20to30ug/h・Bolusdosewas20ug,andLockouttimewas20minutes・Pre-andpost-treatmentVASscoresanddosageofmorphinewererecorded・Bloodpressure,heartrate,respiratoryrateandadversereactio
6、nsweremonitoreddaily.ResultTheshortestandlongestanalgesiatimewas10and32daysrespectively.Thepre-treatmentVASscoreofthe12patientswasmorethan5.Fromday1today14post-treatment,10patientswerecompletelyrelievedfrompain,andtheVASscorewaszero.Other2patientswasrangedfrom1to2.Af
7、ter14days,theVASscoresof9patientswerestillzero.Theaveragemorphinedosagewas1.3+0.5mgperday.Thesideeffectincludednausea,vomiting,urinaryretentionanditchy.Theincideneeofsideeffectwashigherinthefirstweekanddecreasedsignificantly2weekslater・Therewerenoinfectioneventsoccur
8、redinthestudy.ConclusionIntrathecalinjectionofmorphinebyPCAmaybeagoodsupplementalapproachinsomepatientswithintractablecancerpain,Ex
