摘要
目的评价吗啡静脉自控镇痛(PCIA)行多瑞吉(芬太尼透皮贴剂)剂量快速滴定对癌性疼痛的治疗作用.方法收集我院疼痛门诊或住院中、重度癌痛患者34例,采用开放非对照试验使用吗啡PCIA行多瑞吉剂量滴定治疗癌痛.PCIA设定:负荷量,每隔5分钟静注吗啡1～2 mg至患者VAS小于3分;冲击量,1/4～1/3的负荷量;背景量(mg/h),平均每小时口服吗啡量的1/3,并停用口服吗啡;无24 h总量限定.记录24 h静脉吗啡用量,换算成多瑞吉,并保留PCIA冲击量24 h.观察并记录吗啡PCIA前、PCIA中、PCIA加多瑞吉(24 h)和多瑞吉24～72 h患者的疼痛强度和不良反应.结果所有患者在8～24 min获得良好镇痛(VAS＜3分),94.1%的患者换用多瑞吉后能充分有效维持72 h;观察期间主要不良反应有恶心、呕吐和头晕,转换为多瑞吉后不良反应逐渐下降.结论癌痛患者采用吗啡PCIA滴定多瑞吉剂量,可以快速有效镇痛,使多瑞吉应用剂量更加个体化.
Objective To evaluate the effect of dosage of durogesic ( transdermal fentanyl patch) titrated by morphine patient-controlled intravenous analgesia (PCIA) in the treatment of cancer pain. Methods In this open prospective study,thirty-four patients with moderate to severe cancer pain were studied. Before PCIA, pain was assessed by visual analog score (VAS) .The patients were stopped loading dosage (1 to 2 mg per 5 min )until VAS less than 3 scores. The other parameters for morphine PCIA were that the bolus dose was one third or one fourth of loading dose, and a background infusion rate was one third of the amount of peroral morphine dosage every hour.According to the amount of 24 h of intravenous morphine infusion, the dosage of durogesic was calculated. Before morphine-PCIA ,in the period of morphine-PCIA , in the period of durogesic 24 h used with morphine PCIA-Bolus and in the period of durogesic used 24 to 72 h, pain VAS and the side effect were assessed respectively.Results The pain was quickly relieved (VAS<3) within 8 to 24 min, and was sufficiently and effectively maintained for 72 h in 94.1% of the patients. The main side effects were nau-~sea, vomit and dizziness. The ratio of side effect decreased stepwise following durogesic used. ~Conclusion Dosage titration of durogesic using morphine PCIA provides an effective, rapid and individual methods in treatment of moderate to severe cancer pain.
出处
《临床麻醉学杂志》
CAS
CSCD
2005年第5期330-331,共2页
Journal of Clinical Anesthesiology
