Mherekumombe Martha F, Collins John J
The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
J Pain Symptom Manage. 2015 May;49(5):923-7. doi: 10.1016/j.jpainsymman.2014.10.007. Epub 2014 Dec 27.
Pain is a common and significant symptom experienced by children with advanced malignant disease. There is limited research on pain management of these children at home.
To describe and review the indications for using patient-controlled analgesia (PCA) in the form of a Computerized Ambulatory Drug Delivery device (CADD(®)) in the home setting.
A retrospective chart review was conducted in children discharged home with opioid infusions using a CADD. Charts from January 2008 to February 2012 were surveyed.
Thirty-seven CADDs were dispensed during the study period, and of these, 33 were prescribed for patients with cancer-related pain. A third of the CADDs were commenced at home and almost all PCA CADDs were used for end-of-life care. Hydromorphone was the most commonly prescribed opioid. Patients remained at home and pain control was achieved by either increasing the opioid dose or switching the opioid and using adjuvant therapy. Sixteen patients were readmitted to hospital from home and three admissions were related to pain. The median duration on a PCA CADD at home was 33.7 days (range, 1-150 days), and the mean morphine equivalent dose was 2.13 mg/kg/day.
PCA with a CADD can be used to manage pain in the home setting. Dose adjustments and opioid switches were performed with no adverse incidents.
疼痛是晚期恶性疾病患儿常见且严重的症状。关于这些患儿在家中的疼痛管理研究有限。
描述和回顾以电脑化门诊给药装置（CADD(®)）形式使用患者自控镇痛（PCA）在家中的应用指征。
对使用CADD在家中出院的接受阿片类药物输注的患儿进行回顾性病历审查。调查了2008年1月至2012年2月的病历。
在研究期间发放了37个CADD，其中33个是为患有癌症相关疼痛的患者开具的。三分之一的CADD在家中开始使用，几乎所有PCA CADD都用于临终关怀。氢吗啡酮是最常用的阿片类药物。患者居家，通过增加阿片类药物剂量或更换阿片类药物并使用辅助治疗实现了疼痛控制。16名患者从家中再次入院，3次入院与疼痛有关。在家中使用PCA CADD的中位持续时间为33.7天（范围1 - 150天），平均吗啡等效剂量为2.13mg/kg/天。
使用CADD的PCA可用于在家中管理疼痛。进行了剂量调整和阿片类药物更换，未发生不良事件。
