CAJ | 학술논문

背景:临床上慢性癌痛患者常应用阿片类药物镇痛,但仍然有很多不良反应.国内也曾有报道采用海藻酸钠-聚赖氨酸-海藻酸钠微囊化牛肾上腺嗜铬细胞移植治疗慢性癌痛.但聚赖氨酸作为人工合成的阳离子聚合物,价格昂贵,且海藻酸钠聚赖氨酸强度不足,一定程度上限制了其在临床上的应用.而壳聚糖是一类天然高分子多糖,来源广泛、价格低廉且具有良好生物相容性,成为聚赖氨酸良好的替代材料.目的:观察海藻酸钠-壳聚糖-海藻酸钠微囊化牛肾上腺嗜铬细胞异种移植对慢性癌痛患者的镇痛效应、作用持续时间及不良反应.设计、时间及地点;回顾性病例分析,病例来自于2007-01/2008-12大连大学附属中山医院肿瘤科.对象:中、晚期恶性肿瘤患者10例,年龄46～78岁,女1例,男9例.用视觉模拟疼痛评分法评价疼痛程度,中度疼痛3例,重度疼痛7例.方法:用胶原酶加机械法消化分离牛肾上腺嗜铬细胞,二步法包裹于海藻酸钠-壳聚糖-海藻酸钠微囊内.局麻下腰椎穿刺将5 mL微囊化牛肾上腺嗜铬细胞悬液(5～7)×10~6缓慢注入中、晚期恶性肿瘤患者蛛网膜下腔.主要观察指标:移植后疼痛的缓解程度,止痛作用持续时间及不良反应.结果:将微囊化牛肾上腺嗜铬细胞注入患者脊髓蛛网膜下腔后疼痛便得到不同程度的缓解,1周内疼痛完全缓解2例,部分缓解1例,轻度缓解4例,3例未缓解.移植后可出现轻度马尾神经刺激症状,患者诉腰部酸胀,3-5 d内症状消失.结论;海藻酸钠-壳聚糖-海藻酸钠微囊化牛肾上腺嗜铬细胞异种移植于慢性癌痛患者脊髓蛛网膜下腔安全,且能够迅速发挥镇痛作用.
배경:림상상만성암통환자상응용아편류약물진통,단잉연유흔다불량반응.국내야증유보도채용해조산납-취뢰안산-해조산납미낭화우신상선기락세포이식치료만성암통.단취뢰안산작위인공합성적양리자취합물,개격앙귀,차해조산납취뢰안산강도불족,일정정도상한제료기재림상상적응용.이각취당시일류천연고분자다당,래원엄범、개격저렴차구유량호생물상용성,성위취뢰안산량호적체대재료.목적:관찰해조산납-각취당-해조산납미낭화우신상선기락세포이충이식대만성암통환자적진통효응、작용지속시간급불량반응.설계、시간급지점;회고성병례분석,병례래자우2007-01/2008-12대련대학부속중산의원종류과.대상:중、만기악성종류환자10례,년령46～78세,녀1례,남9례.용시각모의동통평분법평개동통정도,중도동통3례,중도동통7례.방법:용효원매가궤계법소화분리우신상선기락세포,이보법포과우해조산납-각취당-해조산납미낭내.국마하요추천자장5 mL미낭화우신상선기락세포현액(5～7)×10~6완만주입중、만기악성종류환자주망막하강.주요관찰지표:이식후동통적완해정도,지통작용지속시간급불량반응.결과:장미낭화우신상선기락세포주입환자척수주망막하강후동통편득도불동정도적완해,1주내동통완전완해2례,부분완해1례,경도완해4례,3례미완해.이식후가출현경도마미신경자격증상,환자소요부산창,3-5 d내증상소실.결론;해조산납-각취당-해조산납미낭화우신상선기락세포이충이식우만성암통환자척수주망막하강안전,차능구신속발휘진통작용.
BACKGROUND: Opiate drugs are widely used to control chronic cancer pain, which brings many adverse reactions. Transplantation of sodium alginate-polylysine-alginate microencapsulated bovine adrenal chromaffin cell (BCC) has reported to be used as chronic cancer pain controllers. However, the high price and poor strength of polylysine limited its clinical application. Chitosan is characterized by sufficient resource, low price and good biocompatibility, which is a substitute for polylysine.OBJECTIVE: To study the effect of xenotransplantation of sodium alginate-chitosan-alginate (ACA) microencapsulated BCC on patients with advanced cancer pain.DESIGN, TIME AND SETTING: A retrospective case analysis. All cases were obtained from Department of Oncology, Affiliated Zhongshan Hospital of Dalian University from January 2007 to December 2008.PARTICIPANTS: Totally 10 patients with advanced cancer, including 1 female and 9 males, aged 46-78 years. According to visual algetic mimic scale (VAS), 3 patients suffered moderate pain and 7 cases suffered severe pain.METHODS: Microencapsulation method was applied to encapsulate BCC with ACA membrane and transplant the microencapsulated BCC (5-7)×10~6 into the subarachnoids pace of 10 patients.MAIN OUTCOME MEASURES: The degree of pain release, duration of analgesic effect, as well as adverse reaction.RESULTS: All 10 patients had pain relief rapidly after transplantation in varying degrees. Complete pain relief was shown in 2 cases, medium relief in 1 case, slight relief in 4 cases. Slight irritation of cauda eguina was presented after transplantation, which could disappear within 3-5 days.CONCLUSION: Xenotransplantation of ACA microencapsulated BCC into the spinal subarachnoids pace of patients with cancer pain can produce analgesic effect promptly, significantly, and safely.