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目的观察口服小剂量氯胺酮对中重度癌痛患者抑郁的疗效及不良反应。方法 80例中重度癌痛伴抑郁患者随机均分为五组,均采用曲马多缓释片和布桂嗪注射液镇痛治疗。其中,A、B和C组分别顿服氯胺酮0.25、0.5和1.0mg/kg,D组口服氟西汀20mg/d,E组口服安慰剂。分别于服药前60min、服药后60、120min及2、4、8、15、21d应用VAS评分评价患者疼痛程度、汉密顿抑郁量表评价患者抑郁程度、中国癌症患者生活质量调查问卷评价患者的生活质量,并记录治疗过程中的不良反应。结果与E组相比,A、B、C、D组患者VAS评分下降(P<0.05);A、B、C组抑郁症状及生活质量均改善(P<0.05)。在服药后120min起效,2d达到最佳效果,且与氯胺酮剂量相关;D组服药后15-21d抑郁症状及生活质量才有改善(P<0.05)。各组均未见明显不良反应。结论口服小剂量氯胺酮治疗中重度癌痛伴抑郁患者疗效确切,不良反应小。
Objective To observe the efficacy and adverse reactions of oral low dose ketamine on depression in patients with moderate to severe cancer pain. Methods Eighty patients with moderate to severe cancer pain and depression were randomly divided into five groups. All patients were treated with tramadol extended-release tablets and buprofezin injection for analgesia. Among them, ketamine (0.25, 0.5 and 1.0 mg / kg) was administered to patients in groups A, B and C, respectively. Group D received fluoxetine 20 mg / d, and group E received placebo. The pain scores were evaluated 60 minutes before medication, 60,120 minutes after medication and 2,4,8,15,21 days respectively. VAS score was used to evaluate the degree of pain in patients. The Hamilton Depression Scale was used to evaluate the degree of depression. The quality of life questionnaire for cancer patients in China was evaluated Quality of life, and record adverse reactions during treatment. Results Compared with group E, the VAS scores of group A, B, C and D decreased (P <0.05). The symptoms and quality of life of group A, B and C improved (P <0.05). After 120 min, it took effect, and reached the best effect on the 2nd day, and was related to the dose of ketamine. Depression symptoms and quality of life in group D were improved 15-21 days after treatment (P <0.05). No obvious adverse reactions were found in all groups. Conclusion Oral low-dose ketamine for the treatment of moderate-severe cancer pain with depression is effective and the adverse reactions are small.