硬膜外埋入式输注系统治疗顽固性癌痛的疗效及安全性

目的 观察硬膜外埋入式输注系统治疗顽固性癌痛的镇痛效果及安全性.方法 顽固性癌痛患者38例,采用硬膜外埋入式输注系统+外接全自动注药泵(PCA泵)持续注药止痛.PCA泵额定容量为300 mL(生理盐水+吗啡+布比卡因)混合液,每天硬膜外腔注入吗啡的剂量根据患者术前每天口服吗啡最大剂量设定(每天口服吗啡剂量除以30换算为硬膜外腔每天吗啡使用量),布比卡因的起始浓度为0.1％.术后PCA泵设定持续注药量及单次给药量,患者疼痛剧烈时可按单次注药键,根据患者疼痛程度可随时调整持续注药量及单次给药量,直到疼痛控制满意.结果 38例患者治疗前后VAS评分比较差异具有统计学意义(P＜0.05),患者生命体征平稳,生活质量较治疗前明显提高(P＜0.05),无严重不良反应发生.结论 硬膜外埋入式输注系统治疗顽固性癌痛镇痛效果确切,安全性高.

Efficacy and Safety of Embedded Epidural Infusion System in Refractory Cancer Pain

Objective To observe the analgesic effect and safety of embedded epidural infusion system in refractory cancer pain.Method 38 patients with refractory cancer pain were included in the study.Medicinal products were continuously infused by an embedded epidural infusion system externally connected with an automatic infusion pump(PCA pump)to relieve pain.The nominal volume of a PCA pump was 300 mL mixed solution(normal saline,morphine and bupivacaine).The doses of morphine infused epidurally were set based on the maximum doses administered orally daily by the patients prior to surgical procedures.(daily doses of morphine infused epidurally were converted by daily doses administered orally divided by 30).The initial concentration of bupivacaine was 0.1%.Continuous infusion doses and single doses were set in PCA pumps after surgical procedures.The ’single infusion’ key could be pressed if patients felt severe pain and continuous infusion doses and single doses could be adjusted at any time until satisfactory analgesic control was obtained.Results The differences between VAS scores before and after treatments were statistically significant(P < 0.05).Vital signs of the patients were stable.Life qualities had been improved remarkably(P < 0.05),compared with those before the treatments.No severe adverse effects occurred.Conclusion It is specifically effective and highly safe for embedded epidural infusion systems to be used in the treatment of refractory cancer pain.