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1、植入性鞘内吗啡输注系统治疗顽固性疼痛的临床观察洪溪龚志毅*陶蔚叶铁虎任洪智黄宇光*王任直中国医学科学院中国协和医科大学北京协和医院麻醉科*神经外科100730【摘要】目的探讨植入性蛛网膜下腔（即鞘内）药物输注系统（ImplantedIntrathecalDrugDeliverySystem,IDDS）在顽固性疼痛治疗中的临床意义。方法：对四例因顽固性疼痛而实施植入性鞘内药物输注系统的病人进行临床效果评价。结果：四例病人中，两例为晚期癌痛，两例为顽固性腰腿痛。所冇病人均曾全身性应用大剂量镇痛药物治疗，镇痛效杲不佳，副作用无法
2、耐受。病人先进行筛选试验，鞘内或硬膜外给予一定量吗啡后，观察到疼痛VAS评分较给约前降低了50%以上，无明显副作用，符合条件。然后经过外科手术将IDDS植入体内，手术顺利，术后经过剂量调整，镇痛效果较明显，副作用减轻。结论：通过IDDS将镇痛药物直接注入作用部位（脊髓和人脑），镇痛效果确切，同时避免了全身给药时的副反应，是针对顽固性疼痛（癌痛和卄癌痛）的三阶梯治疗以外的一种冇效方法。应用时应掌握适应症，并进行严密的筛选试验确定治疗的冇效性，并根据疼痛缓解程度和副作用进行剂量调整。【关键词】：顽固性疼痛；植入性鞘内吗啡输注系
3、统；阿片类药物；筛选试验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
