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目的观察小剂量氯胺酮联合罗哌卡因、芬太尼硬膜外自控镇痛(PCEA)在顽固性晚期癌痛患者中的止痛效果。方法将选择的35例晚期癌痛患者随机分为A组17例和B组18例。A组镇痛泵药液组成:0.894%甲磺酸罗哌卡因40ml,芬太尼0.2mg,氟哌利多5mg加生理盐水至200ml。B组在A组基础上加氯胺酮200mg后加生理盐水至200ml。分别在安装止痛泵后24h、48h、5d、7d采用疼痛视觉模拟评分(VAS)评估疼痛程度,统计48h内PCA按压次数、芬太尼用量及患者恶心、呕吐、嗜睡以及呼吸抑制等镇痛相关并发症发生情况。结果治疗前2组患者VAS评分差异无统计学意义(P>0.05)。治疗后,2组疼痛均明显缓解。A组治疗后24h、48h、治疗后5d VAS评分均低于治疗前,差异有统计学意义(P<0.05),治疗7d VAS评分与治疗前比较差异无统计学意义(P>0.05);B组治疗后各时间点与治疗前比较VAS差异均有显著性(P<0.05)。组间比较:B组治疗后在24h、48h、治疗5d的VAS评分与A组同时点比较差异均无统计学意义(P>0.05),治疗7d VAS评分低于A组,差异有统计学意义(P<0.05)。A组PCA按压次数和芬太尼用量明显多于B组,差异有统计学意义(P<0.05)。A组患者恶心、呕吐、嗜睡以及呼吸抑制等镇痛相关并发症发生率为94.1%(16/17)明显高于B组的11.1%(2/18),差异有统计学意义(P<0.05)。结论经硬膜外小剂量氯胺酮联合罗哌卡因、芬太尼自控镇痛具有镇痛作用强、不良反应小等优点,适合中、重度晚期顽固性癌痛患者的止痛。
Objective To observe the analgesic effect of low dose ketamine combined with ropivacaine and fentanyl epidural analgesia (PCEA) in patients with refractory advanced cancer pain. Methods The 35 patients with advanced cancer pain were randomly divided into group A 17 cases and group B 18 cases. Group A analgesic pump liquid composition: 0.894% ropivacaine mesylate 40ml, fentanyl 0.2mg, droperidol 5mg plus saline to 200ml. B group in group A based on ketamine 200mg plus normal saline to 200ml. Pain was assessed by visual analogue scale (VAS) at 24h, 48h, 5d and 7d after analgesic pump was set up, and the analgesic effects of PCA, the amount of fentanyl and nausea, vomiting, lethargy and respiratory depression Complications of the situation. Results There was no significant difference in VAS score between the two groups before treatment (P> 0.05). After treatment, two groups of pain were significantly relieved. The VAS scores of group A at 24h, 48h and 5d after treatment were lower than those before treatment (P <0.05). There was no significant difference between the two groups on the 7th day after treatment (P> 0.05) There was significant difference in VAS between before and after treatment at each time point (P <0.05). There was no significant difference in VAS score between the two groups at 24h, 48h and 5d after treatment (P> 0.05), and the VAS score at 7d after treatment was lower than that of A group (P <0.05). The number of PCA and fentanyl usage in group A was significantly higher than that in group B, the difference was statistically significant (P <0.05). The incidence of nausea, vomiting, lethargy and respiratory depression were 94.1% (16/17) in group A compared with 11.1% (2/18) in group B (P <0.05) ). Conclusion The small epidural ketamine combined with ropivacaine, fentanyl controlled analgesia has the advantages of strong analgesic effect and low adverse reaction, which is suitable for the patients with moderate and severe refractory cancer pain.