Valente M, Aldrete J A
University of Michigan Medical School, Ann Arbor, USA.
Reg Anesth. 1997 May-Jun;22(3):260-6. doi: 10.1016/s1098-7339(06)80012-x.
Temporary epidural catheter pumps are used to infuse analgesics in patients with chronic intractable pain. Three brands of disposable, nonmechanical pumps adapted for epidural infusion were tested to determine their flow rate efficacy and their cost effectiveness.
Three pump models were tested: the Baxter (2C1075), Homepump (H100020), and SurgiPEACE (SP500-24). Manufacturers of each unit claim to provide a constant 2-mL/h flow rate. A standard setup was used to simulate both the insertion of the catheter into the epidural space and the environmental conditions consistent with patient ambulation. Reservoirs were filled with water and allowed to infuse into a collection receptacle, and flow rates were measured hourly. Four trials were performed with four separate units and flow rate measurements were averaged to determine a flow rate pattern over the entire infusion period. Data were graphed as the percentage of expected flow rate (% of 2 mL/h) versus infusion time (hours), the 90-110% range being defined as acceptable.
All pumps initially infused at a rate above 110% for the first 3-6 hours, after which a steady decline in flow rate was observed. The Homepump produced a flow rate in the acceptable range for the greatest part of its infusion period (41%), followed by the SurgiPEACE (34%), and the Baxter unit (10.4%). The Baxter unit was also cumbersome to handle and therefore difficult to fill. The Homepump unit was easily handled but offered considerable resistance to filling, with partial loss of fluid. The SurgiPEACE unit was easy to handle and fill; however, in two of the units tested, an initial blockage was encountered, and manual patency of the connector and/or catheter had to be established.
All three units deviated considerably from the claimed flow rate of 2-mL/h, both at the beginning and at the end of the infusion. Presumably, the decreasing flow rates are responsible for the diminishing pain relief often experienced by patients over the course of the infusion. The Homepump unit appeared to be the most cost-effective and the easiest to handle and maintained an acceptable infusion rate for the greatest percentage of the infusion period. The considerable cost benefit of using a nonmechanical disposable pump as opposed to a costly but more reliable computerized pump appears to warrant further product improvement and development.
临时硬膜外导管泵用于为慢性顽固性疼痛患者输注镇痛药。对三种适用于硬膜外输注的一次性非机械泵品牌进行了测试，以确定其流速效能和成本效益。
测试了三种泵型号：百特（2C1075）、家用泵（H100020）和外科安宁泵（SP500 - 24）。每个装置的制造商均声称能提供2毫升/小时的恒定流速。采用标准设置来模拟导管插入硬膜外腔的过程以及与患者行走相符的环境条件。储液器装满水后让其输注到收集容器中，每小时测量流速。使用四个独立装置进行了四项试验，并对流速测量值求平均值以确定整个输注期的流速模式。数据以预期流速的百分比（相对于2毫升/小时的百分比）对输注时间（小时）作图，90% - 110%的范围定义为可接受范围。
所有泵在最初3 - 6小时内的输注速率均高于110%，此后观察到流速稳步下降。家用泵在其输注期的大部分时间（41%）内流速处于可接受范围内，其次是外科安宁泵（34%），百特装置（10.4%）。百特装置操作也很麻烦，因此难以填充。家用泵操作简便，但填充时阻力较大，有部分液体损失。外科安宁泵操作和填充都很容易；然而，在测试的两个装置中，最初遇到了堵塞情况，必须手动使连接器和/或导管通畅。
所有三个装置在输注开始和结束时的流速均与声称的2毫升/小时有很大偏差。据推测，流速降低是导致患者在输注过程中经常出现疼痛缓解效果减弱的原因。家用泵似乎是最具成本效益且最易于操作的，并且在输注期的最大百分比时间内保持了可接受的输注速率。与昂贵但更可靠的计算机化泵相比，使用非机械一次性泵具有相当大的成本效益，这似乎值得进一步改进和开发产品。
