针对顽固性颅面癌疼痛患者的鞘内给药系统:一项多中心回顾性研究

Dongju Long,Xinning Li,Yu Zhang,Jia Luo,Bojing Liu,Bo Hong,Fan Yang,Cong Zou,Feng Ge,Aimin Zhang,Huacheng Zhou,Yanying Xiao,Yaping Wang
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引用次数: 0

摘要

背景颅面癌患者经常遭受剧烈疼痛的折磨。传统的鞘内注射、口服或静脉注射镇痛药只能缓解部分疼痛,且副作用较大。因此,需要一种更有效的镇痛方法。本研究旨在探讨将鞘内吗啡泵导管置入桥脑前囊治疗颅面癌疼痛的安全性和有效性。方法 我们对 2019 年 9 月至 2023 年 12 月期间在 11 家医疗中心接受鞘内吗啡泵导管置入桥脑前囊治疗的原发性或转移性颅面癌疼痛患者进行了回顾性研究。弗里德曼检验和配对符号秩检验用于评估术前至术后第1天、第7天和第30天的数字评分量表(NRS)评分、突破性疼痛发作次数、鞘内吗啡剂量和全身吗啡当量(口服、贴敷、静脉注射)剂量的差异。使用 Bonferroni 检验对 P 值进行了多重比较校正。植入后第 1、7 和 30 天的 NRS 评分中位数(四分位数间距 [IQR])分别为 2.0 (1.0-3.5)、2.0 (1.0-2.0) 和 1.0 (1.0-2.0),明显低于术前(中位数,8.0;IQR,7.0-10.0;所有 P <.001)。与基线突破性疼痛发作次数/d(中位数,6.0;IQR,4.5-10.0)相比,植入后第 1 天、第 7 天和第 30 天的突破性疼痛发作次数/d 逐渐减少,中位数(IQR)分别为 1.0(0.0-3.0)、2.0(0.0-3.0)和 0.0(0.0-1.2)(所有 P < .001)。约 78.8% 和 96.7% 的患者在植入后第 1 天和第 30 天分别报告疼痛缓解 >50%。与植入后第 1 天相比,植入后第 30 天疼痛缓解率大于 75% 的患者比例也随着持续鞘内治疗而增加。与基线全身吗啡当量剂量(中位数,228 mg.d-1;IQR,120-408 mg.d-1)相比,全身吗啡当量剂量从植入后第1天的0(0-120)mg.d-1(P = .001)显著降至植入后第7天和第30天的0(0-0)mg.d-1(P均< .001)。少数患者报告了围手术期不良反应,包括恶心、便秘、低血压、尿潴留、口干、头痛和镇静。结论将鞘内吗啡泵的导管尖端插入颅前蓄水池可有效缓解难治性颅面癌疼痛,吗啡总剂量需求极低,不良反应极少。严重的难治性颅面癌疼痛患者可以考虑采用这种方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study.
BACKGROUND Patients with craniofacial cancer frequently suffer from severe pain. The traditional intrathecal, oral, or intravenous analgesics could only provide insufficient pain relief with many side effects. Thus, a more effective analgesia approach is required. This study aimed to investigate the safety and efficacy of placing the catheter of an intrathecal morphine pump in the prepontine cistern for the treatment of craniofacial cancer pain. METHODS We performed a retrospective study of patients with primary or metastatic craniofacial cancer pain who received the catheter placement of an intrathecal morphine pump into the prepontine cistern in eleven medical centers from September 2019 to December 2023. Friedman test and pairwise signed-rank test were used to evaluate the difference in numeric rating scale (NRS) scores, the number of breakthrough pain episodes, dose of intrathecal morphine, and dose of systemic morphine equivalents (oral, patch, intravenous) from preoperative period to postoperative days 1, 7, and 30. P values were corrected for multiple comparisons using Bonferroni test. RESULTS The study included 33 patients. The median (interquartile range [IQR]) of NRS scores at days 1, 7, and 30 postimplant were 2.0 (1.0-3.5), 2.0 (1.0-2.0), and 1.0 (1.0-2.0), respectively, which was significantly lower than that before surgery (median, 8.0; IQR, 7.0-10.0; all P < .001). Compared to baseline number/d of breakthrough pain episodes (median, 6.0; IQR, 4.5-10.0), there was a progressive decrease in the number/d of breakthrough pain episodes at day 1, day 7, and day 30 postimplant, and the median (IQR) were 1.0 (0.0-3.0), 2.0 (0.0-3.0), and 0.0 (0.0-1.2), respectively (all P < .001). Approximately 78.8% and 96.7% of patients reported pain relief >50% at days 1 and 30 postimplant, respectively. Compared with that at day 1 postimplant, the proportion of patients with a pain relief rate >75% at day 30 postimplant also increased with continued intrathecal treatment. Compared to the dose of baseline systemic morphine equivalents (median, 228 mg.d-1; IQR, 120-408 mg.d-1), the dose of systemic morphine equivalents reduced significantly from 0(0-120) mg.d-1 at day 1 postimplant (P = .001), to 0 (0-0) mg.d-1 at days 7 and 30 postimplant (both P < .001). Few patients reported perioperative adverse events, including nausea, constipation, hypotension, urinary retention, dry mouth, headache, and sedation. No severe adverse events occurred. CONCLUSIONS Placing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events. This procedure could be considered in patients with severe refractory craniofacial cancer pain.
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