Wagemans M F, Spoelder E M, Zuurmond W W, de Lange J J
Academisch Ziekenhuis Vrije Universiteit, afd. Anesthesiologie, Amsterdam.
Ned Tijdschr Geneeskd. 1993 Jul 31;137(31):1553-7.
To record the daily morphine doses, the influence of the treatment on quality of life and the incidence of side-effects and complications of continuous intrathecal morphine administration.
Academic Hospital, Free University, Amsterdam.
Prospective.
Forty terminal patients with intractable cancer pain, who had either insufficient pain relief or severe side effects from systemic analgesics were selected for continuous intrathecal administration of morphine. An intrathecal catheter was implanted, tunnelled and connected with a portable infusion pump delivering morphine constantly and if needed on demand. In a pain diary the patients recorded: the number of daily doses of morphine, concomitant medication, pain scores on a visual analogue scale (VAS), extra doses and activities.
The total number of catheter days was 1486. Patients were treated for a mean of 37.2 (range 2-183) days. The mean dose of daily administered morphine was in 30 patients (75%) less than 20 mg. Sufficient pain relief (VAS score < 5) was achieved in 37 patients (92.5%). Three patients had pain due to spinal cord compression, hardly responding to intrathecal morphine. Withdrawal symptoms, post-puncture headache and leakage of fluid could been treated conservatively. The catheter was removed inadvertently 6 times and could be replaced on outpatient basis. Meningitis occurred in 2 patients, who were adequately treated with antibiotics. The catheter could be re-inserted within 10 days.
In terminally ill cancer patients, the continuous intrathecal administration of morphine may be recommended if conventional pain relief fails.
记录鞘内持续注射吗啡的每日剂量、该治疗对生活质量的影响以及副作用和并发症的发生率。
阿姆斯特丹自由大学学术医院。
前瞻性研究。
选择40例晚期癌症顽固性疼痛患者，这些患者要么疼痛缓解不足，要么全身镇痛药出现严重副作用，接受鞘内持续注射吗啡治疗。植入鞘内导管，经皮下隧道引出并与便携式输注泵连接，持续输注吗啡，并根据需要按需给药。患者在疼痛日记中记录：每日吗啡剂量、伴随用药、视觉模拟评分法（VAS）疼痛评分、额外剂量和活动情况。
导管留置总天数为1486天。患者平均治疗37.2天（范围2 - 183天）。30例患者（75%）每日吗啡平均剂量低于20mg。37例患者（92.5%）疼痛得到充分缓解（VAS评分<5）。3例患者因脊髓受压疼痛，鞘内注射吗啡几乎无效。戒断症状、穿刺后头痛和液体渗漏可保守治疗。导管意外拔除6次，可在门诊更换。2例患者发生脑膜炎，经抗生素充分治疗。导管可在10天内重新插入。
对于晚期癌症患者，如果传统止痛方法失败，可推荐鞘内持续注射吗啡。
