全植入式鞘内药物输注系统治疗难治性癌痛患者的镇痛疗效及其不良反应

来源:用户上传      作者:高� 胡鹏涛 崔敬禄 黄佳彬 廖翔 蒋劲 熊东林

　　[摘要] 目的 ^察全植入式鞘内药物输注系统治疗难治性癌痛患者疼痛的疗效及其不良反应。方法 选择2018年6月至2020年12月华中科技大学协和深圳医院收治的41例确诊晚期恶性肿瘤伴难治性癌痛患者为观察对象，对其在常规全身麻醉或椎管内麻醉联合局部麻醉下进行全植入式椎管内药物输注系统，按照吗啡口服量300 mg=静脉量100 mg=硬膜外腔用量10 mg=鞘内用量1 mg给药。评价全植入式鞘内药物输注系统对患者的视觉模拟评分（VAS）、生活质量影响及记录其不良反应情况。结果 术前患者的VAS评分为（7.29±0.22）分，术后3 d患者的VAS评分缓解至（3.78±0.15）分，疼痛程度较治疗前明显降低（t=13.21，P<0.01）;全植入式鞘内药物输注系统植入术后患者疼痛缓解明显，生活质量评分较前明显升高（P<0.01），大部分患者在术后1周缓解为轻中度疼痛;31例（73.8%）患者在2周后随访疼痛程度为轻度（VAS≤3分），其余患者均为中度疼痛;随访30 d，28例患者（66.7%）疼痛程度为轻度，3例患者进展为中度疼痛;植入1个月后，恶心、呕吐、便秘、尿潴留患者人数分别为6例、6例、7例、0例，植入后恶心、便秘不良反应患者较前明显减少（P<0.05）。 结论 全植入式鞘内药物输注系统能快捷、有效、安全地缓解患者的癌痛程度。
　　[关键词] 难治性癌痛;全植入式;鞘内药物输注系统;疗效分析
　　[中图分类号] R730.6 [文献标识码] B [文章编号] 1673-9701（2022）13-0086-04
　　[Abstract] Objective To observe the efficacy and adverse reactions of total implantable intrathecal infusion system in the treatment of cancer pain in patients with refractory cancer pain. Methods A total of 41 patients with advanced malignant tumors and refractory cancer pain admitted to Huazhong University of Science and Technology Union Shenzhen Hospital from June 2018 to December 2020 were selected as the observation subjects. They underwent totally implantable spinal drug infusion system under routine general anesthesia or spinal anesthesia combined with local anesthesia， which was administered according to morphine oral dose 300 mg=intravenous dose 100 mg=epidural dose 10 mg=intrathecal dose 1 mg. The effect of totally implantable intrathecal drug infusion system on the visual analogue scale （VAS）， quality of life was evaluated. And the adverse reactions were recorded. Results The VAS score of the patients was （7.29±0.22）points before surgery and （3.78±0.15） points 3 days after surgery. The degree of pain was lower than that before treatment （t=13.21， P<0.01）. After implantation of totally implantable intrathecal drug infusion system， the patient′s pain was significantly relieved， and the quality of life score was significantly higher than before （P<0.01）. All patients had mild to moderate pain relief one day after surgery. Thirty-one patients （73.8%） had mild pain （VAS≤3 points） during follow-up after two weeks， and the remaining patients had moderate pain. Thirty days after implantation， 28 patients （66.7%） had mild pain， and three patients progressed to moderate pain. One month after implantation， the number of patients with nausea， vomiting， constipation， and urinary retention was 6， 6， 7， and 0， respectively. The adverse reactions of nausea and constipation after implantation were significantly reduced than before （P<0.05）. Conclusion Totally implantable intrathecal drug infusion system can relieve cancer pain quickly， effectively and safely.

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