输液港与全植入泵鞘内输注系统在难治性癌痛中的临床效果比较  

Comparing the efficacy of port and pump intrathecal infusion system on refractory cancer pain

作　　者：徐晓绘 徐立柱[2] 于洋[1] 孙明洁[1] 时飞[1] 陈付强[1] Xu Xiaohui;Xu Lizhu;Yu Yang;Sun Mingjie;Shi fei;Chen Fuqiang(Department of Painology,Qingdao Muninicipal Hospital,Qingdao City,Shandong Province 266011,China;Department of Medical Administration,Qingdao Muninicipal Hospital,Qingdao City,Shandong Province 266011,China;Department of Anesthesiology,Laizhou Hospital of Traditional Chinese Medicine,Yantai City,Shandong Province 261400,China)

机构地区：[1]青岛市市立医院东院疼痛科,青岛市266011 [2]青岛市市立医院东院医务科,青岛市266011 [3]莱州市中医医院麻醉科,烟台市261400

出　　处：《中华疼痛学杂志》2022年第5期643-650,共8页Chinese Journal Of Painology

摘　　要：目的比较数字减影血管造影(DSA)引导下输液港鞘内输注系统与全植入泵鞘内输注系统在难治性癌痛中的临床疗效。方法收集2019年1月至2022年1月在青岛市市立医院东院疼痛科应用鞘内输注镇痛手术的40例腹部难治性癌痛患者,分为输液港组和全植入泵组,每组20例。两组均通过规范的三级阶梯治疗疼痛仍控制不佳或不良反应难以耐受,且患者日口服吗啡剂量大于200 mg。记录两组鞘内治疗前(T0)和治疗后1日(T1)、3日(T2)、7日(T3)、1个月(T4)、2个月(T5)时数字等级评分法(NRS)的疼痛程度、生命质量健康调查简表评分(SF-36)、鞘内日吗啡总剂量、不良反应。结果输液港组与全植入泵组在T0、T1、T2、T3时日吗啡总量(均为3 mg/d左右)在两组间比较差异均无统计学意义(P均>0.05);T4、T5日吗啡总量输液港组分别为(15.4±3.1和23.3±5.5)mg/d明显高于全植入泵组的(9.9±2.6和12.5±2.5)mg/d,差异均有统计学意义(P均<0.05)。输液港组与全植入泵组在T0、T1、T2、T3时点的SF-36评分两组间比较差异均无统计学意义(P均>0.05);在T4、T5时点比较,SF-36评分各项目中输液港组明显低于全植入泵组,差异均有统计学意义(P均<0.05)。两组NRS评分各时点对比差异均无统计学意义(P均>0.05)。输液港组患者术后不良反应发生率高于全植入泵组。结论输液港鞘内输注系统与全植入泵鞘内输注系统对于难治性癌痛均取得显著疗效,患者疼痛均得到有效缓解;两组疗效短期内相当,但随着时程延长全植入泵组疗效更有优势,日吗啡剂量明显较低且患者生活质量较高。Objective To compare the clinical efficacy of semi-implantable port and totally implantable pump under the guidance of DSA on refractory cancer pain.Methods Forty patients with refractory abdominal cancer pain in the Painology Department of the East Hospital of Qingdao Municipal Hospital,from January 2019 to January 2022,were collected and divided into semi-implantable infusion port group and totally implantable pump group,with 20 cases in each group.The patients were treated with standardized three-ladder treatment,but the pain was still poorly controlled or the adverse reactions intolerant,and the daily oral morphine dose was greater than 200 mg in both groups.Numerical rating scale(NRS),the MOS 36-item short-form health survey(SF-36),total intrathecal daily morphine dose and adverse incidence were recorded before(T0)and 1 day(T1),3 days(T2),7 days(T3),1 month(T4)and 2 months(T5)after the intrathecal treatment.Results The daily morphine dose was not significantly different(about 3 mg/d)at T0,T1,T2,and T3 time points between the two groups.The daily morphine dose was significantly higher in the semi-implantable port group(15.4±3.1 and 23.3±5.5)mg/d than that in the totally implantable pump group(9.9±2.6 and 12.5±2.5)mg/d at T4 and T5 time points(P<0.05).The SF-36 scores were not significantly different at T0,T1,T2,and T3 time points between the two groups.The SF-36 score was significantly lower in the semi-implantable port group than that in the totally implantable pump group at T4 and T5 time points(P<0.05).NRS are comparable at each time point in the two groups.Postoperative complications were higher in the semi-implantable port group than that in the totally implantable pump group.Conclusion Both the semi-implantable port and the totally implantable pump methods can significantly alleviate refractory cancer pain,but for longer term treatment,the totally implantable pump method has more advantage,with significantly lower daily morphine consumption and higher quality of life.

关 键 词：癌症疼痛 鞘内药物输注系统 输液港 完全植入式泵 

分 类 号：R730.5[医药卫生—肿瘤]