病例报告16例儿童癌性疼痛皮下PCA泵镇痛疗效观察

Observation on analgesic effect of subcutaneous PCA pump in 16 children with cancer pain

摘要:

目的：探讨晚期肿瘤患儿癌性疼痛皮下PCA(patient-controlled analgesia)泵镇痛的适应症和疗效。方法：纳入沧州市人民医院安宁疗护科2019年10月至2022年7月住院期间癌性疼痛患儿的临床资料。结果：本组病例16例,男8例,女8例；年龄2个月～16岁；其中神经母细胞瘤7例(43.75%),视网膜母细胞瘤1例(6.25%),急性淋巴细胞白血病3例(18.75%),髓母细胞瘤1例(6.25%),尤文样肉瘤1例(6.25%),横纹肌样瘤2例(12.5%),颅内占位1例(6.25%未明确病理类型)；躯体痛7例,内脏痛3例,神经病理性疼痛3例,混合痛3例(躯体痛合并内脏痛)；重度癌痛11例,中度癌痛5例,其中9例就诊前曾接受过镇痛治疗。所有患儿参考《WHO内科疾病儿童持续性疼痛药物治疗指南》,其中予以氢吗啡酮皮下泵6例,吗啡皮下泵8例,舒芬太尼皮下泵2例；患儿轻度缓解1例,中度缓解1例,明显缓解11例,完全缓解3例,中度以上缓解率93.8%。治疗过程中出现氢吗啡酮组嗜睡1例,减量后好转。吗啡组排尿困难1例,经热敷及按摩后症状缓解,可正常排尿。结论：对癌性疼痛患儿进行全面充分的疼痛评估,并予以合适的镇痛方式、镇痛药物及辅助治疗,可有效缓解癌性疼痛。

Abstract:

Objective:To explore the indications and efficacy of subcutaneous PCA (patient controlled analgesia) pump analgesia for cancer pain in children with advanced tumors. Methods: The clinical data of children with cancer pain during hospitalization from October 2019 to July 2022 in the Department of hospice care of Cangzhou people"s hospital were included. Results:There were 16 cases in this group, including 8 males and 8 females; The age ranged from 2 months to 16 years; Among them, 7 cases (43.75%) were neuroblastoma, 1 case (6.25%) was retinoblastoma, 3 cases (18.75%) were acute lymphoblastic leukemia, 1 case (6.25%) was medulloblastoma, 1 case (6.25%) was Ewing like sarcoma, 2 cases (12.5%) were rhabdomyoma, and 1 case (6.25%) was intracranial space occupying; There were 7 cases of somatic pain, 3 cases of visceral pain, 3 cases of neuropathic pain, and 3 cases of mixed pain (somatic pain combined with visceral pain); There were 11 cases of severe cancer pain and 5 cases of moderate cancer pain, of which 9 cases had received analgesic treatment before seeing a doctor.All children referred to WHO guidelines for the treatment of persistent pain in children with medical diseases, including 6 cases of hypodermic pump of hydromorphone, 8 cases of hypodermic pump of morphine and 2 cases of hypodermic pump of sufentanil; There was 1 case of mild remission, 1 case of moderate remission, 11 cases of obvious remission, 3 cases of complete remission, and the remission rate above moderate was 93.8%. During the treatment, 1 case in the hydromorphone group had sleepiness, which improved after reduction. In the morphine group, one patient had difficulty urinating. After hot compress and massage, the symptoms were relieved and the patient could urinate normally. Conclusion: Comprehensive and adequate pain assessment for children with cancer pain, and appropriate analgesic methods, analgesic drugs and adjuvant treatment can effectively relieve cancer pain.