半植入式鞘内输注系统治疗癌性疼痛并发症回顾性分析*

Retrospective analysis of complications of semi-implantable intrathecal drug delivery system in the treatment of refractory cancer pain*

摘要:

目的： 探讨半植入式鞘内输注系统治疗癌性疼痛相关并发症。 方法：回顾分析2018年07月至2020年10月滨州市第二人民医院疼痛科收治并完成的半植入式经鞘内输注系统植入术治疗癌性疼痛患者，收集患者的一般临床资料和辅助检查结果，如性别、年龄、身高、体重指数、术前 ASA 级、肿瘤类型、手术持续时间，穿刺部位等。于术后1周-12月进行定时随访，记录处理患者并发症发生情况。 结果：对116例癌痛患者半植入式鞘内输注系统植入术后并发症随访，发现其中有20例(17.24%)患者出现并发症，其中 13例(11.21%)导管有关：导管打折7例(6.03%)，导管被肿瘤堵塞3例(2.58%)、脑脊液漏3例(2.58%); 泵有关并发症3例(2.58%)，主要是泵故障3例(2.58%)。药物有关并发症4例(3.44%)：吗啡不耐受3例(2.58%)，吗啡无效1例(0.86%)。与无并发症组相比，并发症组患者性别、术前 ASA 级、穿刺部位、肿瘤类型、口服吗啡缓释片日剂量差异均无统计学意义（P均>0.05）。与无并发症组相比，并发症组年龄明显较高（P=0.000），体重指数明显降低（P=0.012），并发症组脊柱转移瘤患者比例较高（P=0.004），手术持续时间较无并发症组长（P=0.000）， 多因素logistic回归分析结果显示，手术持续时间（OR=6.397，95%CI?3.164~15.07，P=0.000）、伴骨转移瘤（OR=1.830， 95%CI 0.4801~7.455, P=0.000）是发生术后并发症的独立危险因素。 结论：半植入式鞘内输注系统治疗癌性疼痛痛术后常见并发症为导管相关并发症。伴有脊柱转移瘤、手术持续时间是影响术后并发症发生的重要危险因素

Abstract:

Abstract： Objective To explore the treatment of cancer pain-related complications with semi-implantable intrathecal infusion system. Methods： A retrospective analysis was performed for patients with cancer pain treated with semi-implantable intrathecal infusion system implantation in the pain department of Binzhou Second People's Hospital from July 2018 to October 2020, and the general clinical data and auxiliary materials of the patients were collected. Examination results, such as gender, age, height, body mass index, preoperative ASA grade, tumor type, duration of surgery, puncture site, etc. Regular follow-up was performed from 1 week to 12 months after the operation to record and deal with the complications of the patients. Results A follow-up of 116 patients with cancer pain after implantation of semi-implantable intrathecal infusion system found that 20 (17.24%) patients had complications, of which 13 (11.21%) were related to catheters: catheter discounts 7 Cases (6.03%), 3 cases (2.58%) of catheter blockage by tumor, 3 cases (2.58%) of cerebrospinal fluid leakage; 3 cases (2.58%) of pump-related complications, mainly pump failure in 3 cases (2.58%). There were 4 cases (3.44%) of drug-related complications: 3 cases (2.58%) of morphine intolerance and 1 case (0.86%) of morphine ineffectiveness. Compared with the uncomplicated group, there were no significant differences in gender, preoperative ASA grade, puncture site, tumor type, and daily dose of oral morphine sustained-release tablets in the complication group (all P>0.05). Compared with the uncomplicated group, the complication group had a significantly higher age (P=0.000), significantly lower body mass index (P=0.012), a higher proportion of patients with spinal metastases in the complication group (P=0.004), and the duration of surgery Compared with the uncomplicated group (P=0.000), the multivariate logistic regression analysis showed that the duration of operation (OR=6.397, 95%CI 3.164-15.07, P=0.000), and the associated bone metastases (OR=1.830, 95 %CI 0.4801~7.455 P=0.000) was an independent risk factor for postoperative complications. Conclusion The common complications after semi-implantable intrathecal infusion system for the treatment of cancer pain are catheter-related complications. Accompanied by spinal metastases and operation duration are important risk factors for postoperative complications