影响植入性鞘内药物输注系统治疗慢性疼痛疗效的研究进展

Influence factors of intrathecal drug delivery systems for chronic intractable pain

背景应用植入性药物输注系统（implantable drug delivery systems, IDDS）是目前治疗慢性难治性疼痛的有效方法之一。然而临床应用中并非所有患者都能取得良好疗效。目的总结国内外近期关于慢性疼痛患者IDDS镇痛治疗影响因素的研究，为临床实践提供解决问题的思路和方法。内容选择合适的患者、镇痛药物以及良好的管理是获得良好效果的基础。导管尖端的位置取决于患者的疼痛平面，药物的选择主要取决于疼痛的性质，药物的半衰期、输注模式、手术因素以及患者及其家庭等多种因素也均影响IDDS镇痛的疗效。趋向对于慢性难治性疼痛，疼痛三阶梯治疗并不能完全有效镇痛，采用IDDS将是慢性难治性疼痛治疗不可替代的方法之一。随着对脑脊液药代动力学的不断认识，鞘内新药物的不断发展和原有药物剂型的改进，优化围手术期管理，IDDS的临床效果将与时俱进。

Background Implantable drug delivery systems （IDDS） is an effective option for the treatment of chronic intractable pain. However, not all patients can achieve ideal effect in clinical application： Objective To summarize the factors that ＇affect chronic pain patients＇ IDDS, and provide new methods and ideas for clinical practice. Content Proper patient selection, drug selection and management are very important for the IDDS analgesia. The position of the catheter tip, choice of drug, transmission model and so on influence the IDDS analgesic effect. Trend Patients with chronic pain treatment requirements are constantly improve, therefore, application of IDDS will provide effective analgesia for patients with chronic intractable pain. The progress in pharmacokinetic of cerebrospinal fluid, drugs for intrathecal injection, implantation procedure, good perioperation management and so on will improve the effects of IDDS.