鞘内药物输注治疗癌性疼痛(王昆)解读.ppt

Methods of conducting drug trials vary among physicians. However, there are three considerations for all pain drug trials: Whether the problems that motivated a particular patient to consider intrathecal drug delivery will be addressed or can be evaluated with the selected trial method and associated trial time frame The length of time during which drug is delivered to the patient’s spine (i.e., bolus versus continuous infusion) The area in the patient’s spine to which drug is delivered (i.e., intrathecal versus epidural administration) For example, single or multiple bolus injections would provide sufficient trial results to determine whether a malignant pain patient will benefit from intrathecal drug delivery with respect to relief of suffering. However, continuous epidural infusion may provide adequate pain relief until life expectancy can be considered against the risks and trauma of the patient undergoing a surgical procedure to implant the drug delivery system. For a nonmalignant pain patient who’s experiencing side effects from oral medications, continuous infusion at doses that mimic the implanted drug delivery system may be the only way to determine whether intrathecal drug delivery will address the problem. These considerations differentiate the trial types . . . [Read the bullets on the slide.] Why should a patient or clinician consider pain drug delivery? An implanted, programmable drug delivery system provides these benefits . . . [Read the bullets on the slide.] 鞘内药物输注治疗癌性疼痛天津医科大学附属肿瘤医院疼痛科 王昆 在肿瘤早期疼痛的发生率为30-40% 晚期增加到了70%-90% 一项最近的meta分析，回顾性分析了52相研究结果，并且发现未能缓解的疼痛大约为64%，在治愈的肿瘤患者中疼痛发生率为33% 所报告的疼痛患者1/3为中度到重度 癌痛治疗的现状 是一种疾病 剧烈疼痛是不可忍受的痛苦 随着肿瘤的进展疼痛加重、多变 具有不可预测性、治疗是滞后的、被动的 超过2个月以上的持续疼痛感觉回路发生多元性变化 爆发痛是治疗欠佳的主要原因之一 持续性疼痛可以导致心理紊乱-加重疼痛-增加难治性疼痛的风险 癌痛的特点 癌痛需要分段管理和治疗： 易于控制疼痛-肿瘤科医生承担； 难治性癌痛-疼痛专科医生协同 有效治疗的方法包括多学科交叉，多模式相结合： 多种类镇痛药物联合 镇痛药物与疼痛介入治疗技术联合 抗肿瘤治疗与镇痛联合 镇痛治疗与心理治疗联合 需要改变癌痛治疗理念 对于顽固性癌痛的有效治疗 Jacox A, et al. AHCPR, 1994. Portenoy R. Oncology 1999;S2:7. 80-90% 的癌痛