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1、植入性鞘內(nèi)嗎啡輸注系統(tǒng)治療頑固性疼痛的臨床觀察洪溪龔志毅*陶蔚葉鐵虎任洪智黃宇光*王任直中國醫(yī)學(xué)科學(xué)院中國協(xié)和醫(yī)科大學(xué)北京協(xié)和醫(yī)院麻醉科*神經(jīng)外科100730【摘要】目的探討植入性蛛網(wǎng)膜下腔（即鞘內(nèi)）藥物輸注系統(tǒng)（ImplantedIntrathecalDrugDeliverySystem,IDDS）在頑固性疼痛治療中的臨床意義。方法：對四例因頑固性疼痛而實施植入性鞘內(nèi)藥物輸注系統(tǒng)的病人進行臨床效果評價。結(jié)果：四例病人中，兩例為晚期癌痛，兩例為頑固性腰腿痛。所冇病人均曾全身性應(yīng)用大劑量鎮(zhèn)痛藥物治療，鎮(zhèn)痛效杲不佳，副作用無法
2、耐受。病人先進行篩選試驗，鞘內(nèi)或硬膜外給予一定量嗎啡后，觀察到疼痛VAS評分較給約前降低了50%以上，無明顯副作用，符合條件。然后經(jīng)過外科手術(shù)將IDDS植入體內(nèi)，手術(shù)順利，術(shù)后經(jīng)過劑量調(diào)整，鎮(zhèn)痛效果較明顯，副作用減輕。結(jié)論：通過IDDS將鎮(zhèn)痛藥物直接注入作用部位（脊髓和人腦），鎮(zhèn)痛效果確切，同時避免了全身給藥時的副反應(yīng)，是針對頑固性疼痛（癌痛和卄癌痛）的三階梯治療以外的一種冇效方法。應(yīng)用時應(yīng)掌握適應(yīng)癥，并進行嚴(yán)密的篩選試驗確定治療的冇效性，并根據(jù)疼痛緩解程度和副作用進行劑量調(diào)整。【關(guān)鍵詞】：頑固性疼痛；植入性鞘內(nèi)嗎啡輸注系
3、統(tǒng)；阿片類藥物；篩選試驗ClinicalevaluationontheimplantedintrathecalopioiddeliverysystemforintractablepainHongXi,GongZhiYi,^Taowei,YeTieHu,RenHongzhi,HuangYuguang,*WangRenZhi.DepartmentofAnesthesiology,*DepartmentofNeurosurgery,PekingUnionMedicalCollegeHospital,Beijing,100730,
4、China[Abstract]ObjectiveToevaluatctheeffeetivcncssandsafctyprofileofimplantedintrathecaldrug(opioid)deliverysystemforthetreatmentofintractablepain.Methods4patientssufferingfromintractablepainweretreatedwithintrathecalmorphineusingimplanteddrugdeliverysystemforpain
5、control.Theclinicaldatawererecordedandanalyzedretrospectivcly.ResuItsThesepaticntsincluded2casesofcancerpain,2casesofbenignbackpainafterbackoperation(FailedBackSyndrome).Allofthemhadtriedbigdosesoforalorintrovenousstrongopioid,withpoorpainreliefandintolerablesidee
6、ffects.Beforetheimplantation,al1patientshadtrialtest,i.e,certainamountofmorphine(referringtothedailysystcmicdosage)wereinjectedintointrathecalorepiduralspacetotestwhetherthepainreliefwouldbesatisfactorywithoutseveresideeffects.TheVASscaledecreasedupto50%ormoreafte
7、rtheintrathecalmorphine,suggestingthepositiveresuItoftrialtest.Theywerethenoperatedandtheintrathecaldrugdeliverysystemwereimplanted.Aftertheoperation,theintrathecalmorphinedosagewereadjustedaccordingtothepainVASscaleaswellasthesideeffectprofile.Allthepatientsshowe
8、dsignificantpainrelief,withoutserioussideeffects.ConclusionTheimplantedintrathecaldrugdeliverysystem,byinfusinganalgesicsdirectlyintothetargetarea（spina
