鞘内药物输注系统用于癌痛治疗时患者和药物的选择  

Selection of patients and drugs for intrathecal drug delivery systems in the treatment of cancer pain

作　　者：骆丽慧[1] 冯智英[1] 

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州310003

出　　处：《国际麻醉学与复苏杂志》2012年第12期845-848,共4页International Journal of Anesthesiology and Resuscitation

基　　金：基金项目：浙江省卫生厅课题（2010KYA085）

摘　　要：背景应用鞘内药物输注系统（intrathecaldrugdeliverysystems，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。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.

关 键 词：鞘内 癌症 疼痛 阿片类药物 选择 

分 类 号：R730.5[医药卫生—肿瘤]