植入式鞘内药物输注系统用于顽固性癌痛患者的疗效及安全性分析

摘要

Objective:To evaluate the efficacy and safety of continuous intrathecal morphine infusion system for patients with refracto-ry cancer pain. Methods:Seventeen patients with refractory cancer pain were implanted with intrathecal catheters and connected with a continuous external electronic patient-controlled analgesia (PCA) pump for intrathecal morphine analgesia. Visual analogue scales (VAS) score, the dose of routine opioids, and the score for quality of life before and after intrathecal analgesia were recorded. Adverse reactions were observed. Results:After the application of continuous intrathecal morphine analgesia, the VAS score of pain was 2.9±1.8, which is lower than 7.2±2.5 before intrathecal analgesia (P<0.001). Moreover, the dose of routine opioids (i.e., equianal-gesic dose of morphine) was 42.1 ± 7.5 mg/day, which is significantly lower than 282.9 ± 95.5 mg/day before intrathecal analgesia (P=0.004). The scores of general activity, mood, and sleep after intrathecal analgesia were significantly lower than those before intrathe-cal analgesia (P<0.05). However, the analgesic satisfaction of patients considerably increased after intrathecal analgesia (P<0.001). Ad-verse reactions included withdrawal syndrome, headache, urinary retention, and intrathecal infection. Conclusion:The continuous in-trathecal morphine infusion with PCA is effective and safe on analgesic treatment for patients with refractory cancer pain.%目的：评估植入式鞘内药物输注系统用于顽固性癌痛患者镇痛治疗的有效性及安全性。方法：回顾性分析2012年11月至2016年1月四川大学华西医院疼痛科收治的17例患者，其中男性13例，女性4例。对顽固性癌痛患者实施植入式鞘内药物输注系统外接患者自控镇痛（patient controlled analgesia，PCA），观察并记录鞘内镇痛前后患者的视觉模拟评分法（visual analogue scales，VAS）评分、吗啡用量和各项生活质量的评分，同时观察鞘内镇痛的不良反应。结果：17例患者实施鞘内镇痛后的VAS为（2.9±1.8）分，显著低于鞘内镇痛前VAS（7.2±2.5）分（P<0.001）；常规途径使用的阿片类药物（相当于吗啡的镇痛剂量）为（42.1±7.5）mg/d，与鞘内镇痛前（282.9±95.5）mg/d相比，显著降低（P=0.004）；鞘内镇痛后患者日常生活、情绪和睡眠的生活质量评分较鞘内镇痛前均显著降低（P<0.05）；患者镇痛满意度则较鞘内镇痛前显著增加（P<0.001）。鞘内镇痛的不良反应包括戒断症状、低颅压性头痛、尿潴留和颅内感染。结论：植入式鞘内药物输注系统外接PCA可安全有效的用于常规途径阿片类药物镇痛无效的顽固性癌痛患者。