CAJ | 학술논문

背景应用鞘内药物输注系统(intrathecal drug delivery systems,IDDS)是目前癌痛介入治疗的有效方法之一.选择合适的患者和镇痛药物,以及有效的管理是获得良好效果的基础.虽然国际上有相关共识和指南,但关于癌痛患者和药物的选择尚无定论. 目的通过文献检索和阅读,综述最新关于晚期癌痛患者IDDS镇痛治疗时患者和药物的选择的观点,旨在为临床实践提供新的方法和思路. 内容随着鞘内镇痛药物和管理的进展,目前认为预期寿命小于3个月的患者也可应用IDDS;植入前测试在癌痛患者并非必须；药物的选择主要取决于病因是神经病理性、伤害性或者混合性疼痛；加强鞘内镇痛初期和换药时的监测. 趋向肿瘤的日趋高发及其治疗后生存率的提升使得癌痛发生日趋增多,WHO癌痛三阶梯指南不能完全有效镇痛,而应用IDDS将是顽固性癌痛治疗的不可替代的方法之一.
배경 응용초내약물수주계통(intrathecal drug delivery systems,IDDS)시목전암통개입치료적유효방법지일.선택합괄적환자화진통약물,이급유효적관리시획득량호효과적기출.수연국제상유상관공식화지남,단관우암통환자화약물적선택상무정론. 목적 통과문헌검색화열독,종술최신관우만기암통환자IDDS진통치료시환자화약물적선택적관점,지재위림상실천제공신적방법화사로. 내용 수착초내진통약물화관리적진전,목전인위예기수명소우3개월적환자야가응용IDDS;식입전측시재암통환자병비필수；약물적선택주요취결우병인시신경병이성、상해성혹자혼합성동통；가강초내진통초기화환약시적감측. 추향 종류적일추고발급기치료후생존솔적제승사득암통발생일추증다,WHO암통삼계제지남불능완전유효진통,이응용IDDS장시완고성암통치료적불가체대적방법지일.
Background Intrathecal drug delivery systems (IDDS) may represent an effective option for these patients with moderate-to-severe intractable cancer pain.Proper patient selection,drug selection and management are very important for the safety and effectiveness of IDDS analgesia.So far,there is no universally accepted program though recommendations from an interdisciplinary expert panel had published.Objective The purpose of this review to provide updates on cancer patients' selection and drugs seletion for IDDS,and aim to provide the new idea for IDDS in cancer pain by reviewed newly relative literatures and clinical studies.Content The advent of new algorithmic tracks for nociceptive pain and neuropathic pain is an important step in improving cancer patient analgesia.Preimplantation trialing may be unnecessary for cancer IDDS.Patients with less than 3 months of life expectancy are also accepted for IDDS in the new recommendations.Trend With increasing survival rate in cancer,the prevalence of cancer pain is also increasing in number.The specialist advocates for a much wider application of IDDS therapy to provide effective analgesia for patients with cancer pain,including those at the end of life.