皮下持续输注癌痛治疗中国专家共识(2020版)

Consensus of continuous subcutaneous infusion for cancer pain management in China(2020)

皮下持续输注癌痛治疗方法主要用于治疗难治性癌痛和爆发痛,以及阿片类药物的剂量滴定和快速调整。患者自控皮下镇痛(PCSA)突出了患者自控镇痛(PCA)技术的特色和皮下途径给药的独特优势,PCA是根据患者的个体情况,预先设置给药参数,由患者"主动参与"和"自我管理"的镇痛技术,PCA可维持稳定的血药浓度并有效镇痛,及时治疗爆发痛。皮下组织血管丰富,药物吸收良好,药物直接进入血液循环,避开了消化道的吸收和首过效应;可选择的皮下穿刺部位多,不受血管条件的限制;皮下留置针可较长时间留置,微量药物不易蓄积。患者依从性好,满意度高。由口服转换为皮下途径给药的等效剂量为2∶1,按照此计算等效剂量的2/3量开始实施PCSA,然后再进行个体化滴定。在选择微创给药方法治疗癌痛时,可优先选PCSA。

Continuous subcutaneous infusion analgesia mainly used in the treatment of intractable cancer pain and breakthrough pain,as well as opioid dose titration and rapid adjustment.Patient-controlled subcutaneous analgesia(PCSA)highlighted the characteristics of patient-controlled analgesia(PCA)technology and the unique advantages of subcutaneous administration of medicine.PCA can pre-set the parameters of pharmacotherapy according to the individual situation of patients,and the patients can"actively participated"and"self-managed"pain management.PCA can maintain stable blood drug concentration and effective analgesia,and can timely treat breakthrough pain.The subcutaneous tissue is rich in blood vessels,and the medicine is well absorbed.The medicine enters the blood circulation directly,avoiding the absorption and first-pass effect of the digestive tract.There are many alternative subcutaneous puncture sites,which are not restricted by vascular conditions.The subcutaneous indwelling needle can be used for a long time,and the small amount of medicine is not easy to accumulate.Patients have high compliance and satisfaction.The equivalent dose of the medicine converted from oral to subcutaneous route was 2∶1,and the PCSA was administered at 2/3 of the equivalent dose,and followed by an individualized titration.PCSA may be preferred when selecting minimally invasive pharmacotherapy methods.