CAJ | 학술논문

鞘内药物输注系统永久植入术治疗顽固性疼痛病人18例
초내약물수주계통영구식입술치료완고성동통병인18례
Intrathecal drug delivery system in the treatment of chronic intractable pain: a report of 18 cases

万方数据

中华麻醉学杂志中華痳醉學雜誌 중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年 2期 176-179 ,共4页

熊东林%廖翔%张强%郑虎山%肖礼祖%蒋劲%沙彤%罗裕辉%梁豪文%张德仁

웅동림%료상%장강%정호산%초례조%장경%사동%라유휘%량호문%장덕인

输注泵,植入型%注射,脊髓%疼痛,顽固性輸註泵,植入型%註射,脊髓%疼痛,頑固性
수주빙,식입형%주사,척수%동통,완고성
Infusion pumps,implantable%Injections,spinal%Pain,intractable

鞘内药物输注系统(IDDS)永久植入术治疗顽固性疼痛病人18例,其中晚期癌痛病人13例,非癌痛病人5例.首先行筛选试验,随后行IDDS永久植入术.癌痛病人采用视觉模拟评分(VAS评分)及QLQ-C30生活质量评分(QLQ-C30)法,非癌痛病人采用VAS评分法,评价疼痛程度,记录副作用及并发症的发生情况,癌痛病人随访至死亡,非癌痛病人均获得随访至今.术后所有病人经短期鞘内给药量调整后,VAS评分降低,癌痛病人QLQ-C30评分升高.部分病人出现恶心呕吐、便秘、尿潴留、皮肤瘙痒、镇静过度等,约1周均明显缓解,无持续残留症状.术中拔除穿刺针时误割断鞘内导管1例;导管与泵的金属接口过度磨擦至导管破裂,出现渗液1例;术后出现低颅压2例,脑脊液渗漏1例,右小腿后外侧持续性神经病理性疼痛1例,无伤口感染、裂开、愈合不良,无导管渗漏、破裂、异位、折叠、被结扎或肉芽肿形成,无泵翻转、位置异常等,设备本身无故障出现.
초내약물수주계통(IDDS)영구식입술치료완고성동통병인18례,기중만기암통병인13례,비암통병인5례.수선행사선시험,수후행IDDS영구식입술.암통병인채용시각모의평분(VAS평분)급QLQ-C30생활질량평분(QLQ-C30)법,비암통병인채용VAS평분법,평개동통정도,기록부작용급병발증적발생정황,암통병인수방지사망,비암통병인균획득수방지금.술후소유병인경단기초내급약량조정후,VAS평분강저,암통병인QLQ-C30평분승고.부분병인출현악심구토、편비、뇨저류、피부소양、진정과도등,약1주균명현완해,무지속잔류증상.술중발제천자침시오할단초내도관1례;도관여빙적금속접구과도마찰지도관파렬,출현삼액1례;술후출현저로압2례,뇌척액삼루1례,우소퇴후외측지속성신경병이성동통1례,무상구감염、렬개、유합불량,무도관삼루、파렬、이위、절첩、피결찰혹육아종형성,무빙번전、위치이상등,설비본신무고장출현.
From November 2003 to May 2010, intrathecal drug delivery system (IDDS) was implanted in 18 patients with chronic intractable pain. Analgesia was provided with morphine. Thirteen patients suffered from late stage cancer and 5 from diseases other than cancer. VAS score was used to measure intensity of pain in all 18patients. QLQ-C30 score was used to evaluate quality of life in cancer patients. The patients were followed up for 3-62 months in 5 non-cancer patients. All 13 cancer patients died at 57 days-10 months after operation. VAS scores were significantly decreased and QLQ-C30 scores increased by intrathecal administration of morphine. Side effects developed in all patients to some extent including nausea, vomiting, constipation, urinary retention, pruritus and over-sedation and vanished in a week. Intrathecal catheter was cut while being pulled out of the needle in 1 patient. Two patients developed low intracranial pressure after operation. Cerebrospinal fluid leakage occurred in 1 patient. One patient developed neuropathic pain in the posterolateral side of right leg.