静脉自控镇痛用于治疗阿片药物耐受患者伴发中重度疼痛300例观察

摘要

Objective:To investigate the effect on patients with venous self-control analgesia for the treatment of opioid drug resistance with moderately severe pain.Methods:To choose from January 2014 to June 2016,300 cases of patients with moderately severe pain due to poor pain control in hospital.All patients on the basis of the original used painkillers,plus intravenous self-control analgesia to relieve pain.Morphine injection to join self-control analgesia pump and take the "background infusion + patient controlled" model infusion,15 to 20 minutes,normal background infusion for 0.5~1 mg/h + patient controlled 0.5~1 mg/h.Background infusion and dose adjustments according to the patients'' pain,the pain relief situation,situation of quality of life score and adverse reactions were observed.Results:Of the 300 patients,267 cases of patients to achieve analgesia in 3 days,the total effective rate was 89%,the NRS score decreased significantly.After one month of follow-up results showed that 229 cases of pain control is satisfied,17 cases because of the pain worse readmission,12 cases died,9 patients were lost to follow-up.Nausea and vomiting,constipation,urinary retention,dizziness,sleepiness,not seen increased incidence of adverse reactions,has not occurred respiratory inhibition and bradycardia.Patient appetite,sleep,mental state,fatigue and daily life ability of quality of life were improved significantly.Conclusion:Vein controlled analgesia was simple,safe,effective,rapid,stable,low incidence of adverse reaction,improve the quality of life,is suitable for the treatment of opioid drug resistance patients with moderately severe pain,worthy of clinical popularization and application.%目的:探讨静脉自控镇痛用于治疗阿片药物耐受患者伴发中重度疼痛效果.方法:选择2014年1月至2016年6月因疼痛控制不佳而入院或转入我科的中重度癌痛患者300例,所有患者均在原所用止痛药基础上,加用静脉自控镇痛进行止痛.吗啡注射液加入自控镇痛泵,采取"背景输注+病人自控"模式输注,时间15~20分钟,常规背景输注为0.5~1 mg/h+病人自控0.5~1 mg/h.背景输注和自控剂量根据患者疼痛情况进行调整,观察患者疼痛缓解情况、生活质量评分情况及不良反应.结果:300例患者中,267例患者在3日内达到镇痛目标,总有效率为89%,NRS评分显著降低.1月后随访结果显示:229例疼痛控制仍满意,17例由于疼痛加重再次入院,12例死亡,9例患者失访.恶心呕吐、便秘、尿潴留、头晕、嗜睡等不良反应未见增加,未发生呼吸抑制和心动过缓.患者食欲、睡眠、精神、疲乏状态及日常生活能力生活质量均得到明显改善.结论:静脉自控镇痛简便、安全、有效、迅速、稳定,不良反应发生率低,显著提高生活质量,适合阿片药物耐受患者伴发中重度疼痛的治疗,值得临床推广应用.