Intrathecal Drug Delivery System with Programmable Morphine Pump for Pain of Terminally Ill Cancer Patients

脊椎腔內藥物給予系統以嗎啡可調控式幫浦來治療癌症末期疼痛的病人

李昆興(Kung-Shing Lee) ； 朱光興(Kowng-Shing Chu) ； 鍾嘉勵(Chia-Li Chung) ； 林志隆(Chiuh-Lung Lin) ； 黃旭霖(Shiuh-Ling Hwang) ； 洪純隆(Shen-Long Howng)

《中華民國癌症醫學會雜誌》 25卷3期 (2009/06) Pp. 159-166

https://doi.org/10.6588/JCOS.2009.25.3.1

摘要

遵照世界衛生組織對於癌症疼痛的處理準則，有80%至90%的病人他們的疼痛是可以得到良好控制。然而10%至20%的病人，他們就需要更積極的處置。對於癌症末期疼痛難耐、無法忍受的病人，脊椎腔內嗎啡藥物治療，提供此類病人另一種選擇。我們使用全部植入的「可調控式幫浦系統」作為治療的優先選擇。它有一些好處，也可以降低感染的機會。其與手術步驟或機械設計相關之嚴重的併發症是相當罕見，輕微的併發症則較常見。就整體癌症疼痛病人而言，導管、手術步驟、機械設計相關和疾病本身有關的不良事件，每年每人發生0.45次。經過良好的篩選病人，適當的外科與處置，脊椎腔內藥物給予系統，可以讓嗎啡的劑量經由前腹壁內中的可調控式幫浦，隨意又精確的注入病人體內，更無須把藥物抽出後、再重新調整新濃度。此型「可調控式幫浦系統」雖然價錢較昂貴，但仍比其他種設計優點甚多。對於癌症疼痛處置，這種化學性的神經調控，可能讓以往高危險性開刀患者又需要進行「神經破壞手術」的案例減少許多。經過謹慎仔細的接近病人，良好的手術技巧與耐心的藥物劑量調整，脊椎腔內藥物給予系統以嗎啡「可調控式幫浦系統」，來治療癌症末期疼痛難耐的病人，這提供另一種治療選擇，副作用也相當低。

關鍵字

脊椎腔內藥物給予系統 ； 嗎啡 ； 可調控式幫浦系統 ； 癌症疼痛 ； 神經調控

並列摘要

By following the guidelines of the World Health Organization, cancer pain can be well controlled in 80-90% of patients. However, 10-20% will required more intensive measures to control pain. In terminally ill cancer patients with refractory pain, intrathecal opioid therapy may provide an option. We use the type of totally implanted, programmable pump system as the choice of treatment. It has some benefits and may reduce the risk of infection compared to the long-term use of external systems. Serious procedure and device related complications are rare. Minor complications are common. In a population of cancer patients, catheter, procedure, device-related and illness-associated adverse incidents occurred at a rate of 0.45 events per patient year. After proper patient selection and under appropriate surgical management techniques, intrathecal drug delivery system (IDDS) with programmable morphine pumps may allow the drug dosage to be changed precisely and easily without the need to withdraw medication from the drug port and replace it with a new concentration. We believe this advantage makes the programmable pump preferable to those other device systems, despite its somewhat higher cost. This makes chemical neuromodulation a more established means of pain management, possibly eliminating the need for neurodestructive procedures in those terminal cancer pain patients with high operative risk. Under meticulous approach, good surgical techniques and patient adjustments of intrathecal dosage, IDDS with programmable morphine pump may provide an optional therapy with minimal side effects for terminal cancer patients with refractory pain.

並列關鍵字

Intrathecal drug delivery system ； Morphine ； Programmable pump ； Cancer pain ； Neuromodulation