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1、腰段硬膜外埋入式输注系统在顽固性腹部癌痛患者临腰段硬膜外埋入式输注系统在顽固性腹部癌痛患者临床中的应用研究床中的应用研究专业： 麻醉学硕士研究生： 导师： 主任医师中文摘要中文摘要晚期癌症疼痛是癌症患者当中比较常见的一种症状，大约 50%-80%的癌症患者均会出现不同程度的疼痛，晚期癌症患者出现癌症疼痛的几率更是高达 60%-90%。世界卫生组织(World Health Organization 简称 WHO)曾经在 2000 年提出了达到“是癌症患者无痛”的目标，但是至今为止并未能够实现。传统的治疗方式主要采用三阶梯止痛，主要是按照患者癌症疼痛的轻度、中度、重度等不同程度分别予以第一阶梯、
2、第二阶梯、第三阶梯的止痛药物。给药时提倡患者能口服尽量口服，若不能口服便尽可能采取无创给药的方式，给药要按时并非按需。但是其止痛效果并不理想，因此，需要探究腹部癌痛患者的止痛方式。在腰段硬膜外埋入式输注系统当中，主要在患者皮下植入一根导管，导管的一端通向脊髓硬膜外腔，另一端则接入给药泵埋入患者皮下，药物通过给药泵能够直接输入到患者脊髓硬膜外。其目的在于将患者比较复杂的静脉、动脉、腹腔、脊柱注射以及药物的输注转变成为相对简单的皮下穿刺，以此减少重复穿刺的次数，避免对患者的硬膜以及蛛网膜产生刺激，降低患者在注射药物时的疼痛程度与不良反应发生率。但是对于腹部癌痛患者的临床止痛治疗，采用腰段硬膜外埋入
3、式输注系统的效果尚且缺乏统一的定论，本文主要探究腰段硬膜外埋入式输注系统对腹部癌痛患者的止痛效果，以期可以为腹部癌痛患者的临床治疗提供理论依据。目的：目的：探究腰段硬膜外埋入式输注系统对腹部癌痛患者的止痛效果，为腹部癌痛患者的临床治疗提供理论依据。方法：方法：本次研究选择 2014 年 8 月-2016 年 8 月在本院接受治疗的 72 例腹部癌痛患者作为研究对象，将患者按照入院方式分为对照组和观察组，每组患者 36 例。对照组患者采用静脉输注麻醉镇静处理方式，观察组患者采用腰段硬膜外埋入式输注系统，对比两组患者的临床效果。结果：结果：治疗后，观察组患者各项生命体征与对照组相比具有统计学意义（
4、P0.05）。且观察组患者治疗前后 HR、R、P、DBP、SBP 及 SPO2等指标变化相对平稳，与治疗前对比差异无统计意义（P0.05）。经过治疗后，观察组患者轻度缓解率为 13.89%，明显缓解率为 55.55%，对照组患者轻度缓解率为 27.78%，明显缓解率为 27.78%，两组数据对比差异具有统计学意义（P0.05）。两组患者在部分缓解及完全缓解方面对比差异无统计学意义（P0.05）。观察组患者的总缓解效果明显好于对照组，数据对比差异有统计意义（P0.05）。观察组患者在治疗后疼痛评分与对照组相比差异具有统计学意义（P0.05）。观察组患者与对照组患者治疗前肿瘤生活质量评分对比差异无
5、意义（P0.05），治疗后观察组肿瘤生活质量评分为（45.263.37）分，对照组为（38.624.02）分，观察组患者评分明显高于对照组，数据对比差异有统计意义（P0.05）。观察组患者的物质能力、行为能力、心理评分及健康评分等情况均好于对照组，且数据对比差异有统计意义（P0.05）。观察组患者的并发症率为 13.89%，对照组患者的并发症率为 41.67%，观察组患者并发症率低于对照组，且数据对比差异具有统计学意义（P0.05）。观察组患者每天治疗药物的使用时间为（8.84.9）h，对照组为（22.46.2）h，观察组患者用药治疗时间明显少于对照组，且数据对比差异具有统计学意义（P0.05
6、）。结结 论：论：1 腰段硬膜外埋入式输注系统可以稳定患者的生命体征，降低对患者的影响，具有较高的安全性。2 腰段硬膜外埋入式输注系统对于腹部癌痛患者具有较高的止痛效果，且系统在 2h 内效果显著。3 腰段硬膜外埋入式输注系统可以提升患者的生活质量。4 腰段硬膜外埋入式输注系统可以降低腹部癌痛患者治疗中的并发症，继而提升患者的临床治疗效果。5 腰段硬膜外埋入式输注系统用药时间短，可以最快时间发挥效果，降低患者的痛苦。总之，腰段硬膜外埋入式输注系统对于腹部癌痛患者的临床治疗具有较好的效果，且安全性较高，具有较高的临床应用和推广价值。关键词：埋入式输注系统；腹部癌痛；硬膜外；关键词：埋入式输注系统
7、；腹部癌痛；硬膜外；PCA 泵泵Lumbar epidural infusion of embedded type system for clinical application in patients with intractable abdominal painMajor：AnesthesiologyMaster：Supervisor: Prof. ABSTRACTBackground: Advanced cancer pain is a symptom of cancer patients were more common, about 50%-80% of cancer patient
8、s will have varying degrees of pain, the probability of emergence of cancer pain in patients with advanced cancer is as high as 60%-90%. WHO (World Health Organization referred to as WHO) was proposed in 2000 to achieve “painless“ cancer patients, but so far has not been able to achieve. Traditional
9、 treatment mainly adopts three ladder analgesic, mainly in accordance with the cancer pain patients with mild, moderate and severe degree respectively in different One step, second step, third step analgesic drugs. When administered to patients can promote oral oral and oral will be taken if not non
10、-invasive drug delivery, delivery on time is not required. But its analgesic effect is not ideal, therefore, need to explore ways of relieving pain in patients with abdominal pain.In the lumbar embedded epidural infusion system, mainly in patients with subcutaneous implantation of a catheter cathete
11、r, leading to the end of the spinal epidural cavity, the other end is connected to the pump in patients with subcutaneous drug, drug through the dosing pump can be directly input to the patients with spinal epidural. Its goal lies in the patients with complicated vein, artery, abdominal cavity, spin
12、al injection and drug infusion into subcutaneous puncture is relatively simple, in order to reduce the number of repeated puncture, to avoid stimulation on patients with dural and arachnoid, reduce the incidence of adverse reactions and pain during injection. But the clinical abdominal cancer pain a
13、nalgesic therapy , using lumbar epidural infusion: effect of embedded system lack of unified theory, this paper mainly explores the lumbar embedded epidural infusion system on analgesic effect of abdominal cancer pain patients, in order to provide theoretical basis for clinical treatment of abdomina
14、l cancer pain patients.Objective:Explore the lumbar embedded epidural infusion system on analgesic effect of abdominal cancer pain patients, and provide a theoretical basis for clinical treatment of abdominal cancer pain patients.Methods:In this study, 72 cases of abdominal cancer patients choose Au
15、gust 2014 -2016 year in August treated in our hospital as the research object, the patients according to admission were divided into control group and observation group, 36 cases in each group. The control group was treated with intravenous sedation treatment, observation group were treated by lumba
16、r epidural embedded. Injection system, the clinical effects were compared between two groups.Results:After treatment, the observation group has statistical significance of vital signs of patients compared with the control group (P 0.05).After treatment, the observation group of patients with mild remission rate was 13.89%, significant remission rate was 55.55%, the control group of patients with mild remission rate was 27.78%, significant remission rate was 27.78%, statistica
