课件：鞘内药物输注治疗癌性疼痛王昆课稿.ppt

* 回顾28个月,79例8周的追踪 患者减少疼痛的比例（定义为“疼痛”最差评分在重症范围 7-10),由86 ％降至17％( p 0.001 ） 数值明显 ? 疼痛分数?从 7.9 + 1.6 到 4.1 + 2.3 （ p 0.001 ） 口服阿片摄入： 588mg/day口服吗啡当量每天 294mg/day （ p 0.001 ） 鞘内镇痛是有效的治疗难治性癌痛 疼痛控制 略好 毒性分数 明显下降 生活质量（病人及家庭） 明显好 生存 明显好 鞘内注射阿片类药物： 癌症相关疼痛 吗啡-FDA认证 氢吗啡酮-作用与吗啡类似 芬太尼、舒芬太尼 局麻药-布匹卡因、罗哌卡因 可乐定、替扎尼定 氯胺酮 齐考诺肽 激素、非甾体抗炎镇痛药物 鞘内药物 吗啡 ·20mg/ml 15mg/day 氢吗啡酮 ·10mg/ml 4mg/day 芬太尼 ·2mg/ml 未知药物的上限 舒芬太尼 ·50μg 未知药物的上限 布匹卡因 ·40mg/ml 30mg/day 可乐定 ·2mg/ml 1.5mg/day 齐考诺肽 ·200μg/ml 19.2μg/day 推荐鞘内给药物的浓度和剂量 一线药物 吗啡 ··氢吗啡酮 ··1齐考诺肽 二线 芬太尼 ··吗啡/氢吗啡酮＋齐考诺肽 可乐定、布匹卡因 三线用药 可乐定 吗啡/氢吗啡酮/芬太尼 ＋布匹卡因 四线药物 舒芬太尼 舒芬太尼＋布匹卡因 ＋可乐定＋齐考诺肽 五线药物 ··罗哌卡因，丁丙喏啡，咪唑达伦，哌替啶，酮咯酸 六线药物 实验性用药，加巴喷丁，奥曲肽，新斯的明，腺苷 2007美国专家共识 感染 出血 脑脊液漏 导管相关问题：折管、破裂 机械故障：少见 用药相关问题：呼吸抑制、疼痛过敏、肉芽肿 并发症 SynchroMed? II Drug Infusion System  手术流程 THANK YOU SUCCESS * * 可编辑 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 th