经皮下输注装置鞘内吗啡镇痛的疗效及经济学评价
|
摘要
目的:评估经皮下输注装置鞘内输注吗啡治疗癌性疼痛的有效性和经济性。方法:收集2017年4月至2018年4月采用经皮下输注装置鞘内吗啡输注治疗的32例晚期癌痛病例,统计患者的疼痛程度、住院时长和住院费用等一般信息,评价鞘内镇痛对癌痛患者疼痛程度、日常生活能力和镇痛药物用量的影响,分析患者鞘内镇痛前后每日镇痛所需费用的变化,以及鞘内镇痛前后每日镇痛费用的差额与住院费用平衡所需时长。结果:行鞘内镇痛术的癌痛患者平均疼痛持续时间为(10.6±9.7)月,平均住院时长和住院费用分别为(13.0±5.8) d和(48 237.0±11 137.0)元。鞘内镇痛能够显著降低癌痛患者的疼痛程度(VAS评分:6.81±0.16 vs. 2.69±0.22)、镇痛药物用量[(105.94±23.04) mg vs.(1.62±0.44) mg]和每日镇痛费用[(211.71±99.31)元vs.(5.62±0.15)元],但对患者的日常生活能力没有显著的改善作用(68.75±25.84)vs.(65.47±25.09)。鞘内镇痛前后每日镇痛费用的差额与住院费用抵消所需要的平衡时间为(515.87±325.56) d。结论:经皮下输注装置鞘内吗啡镇痛能够有效治疗晚期癌痛,减少镇痛药物用量和每日镇痛费用,但不能改善患者的生活质量和降低癌痛患者的总镇痛费用。
OBJECTIVE To assess the analgesic effect and economics of intrathecal morphine infusion via percutaneous device for treatment of cancer pain.METHODS A total of 32 cases of patients with advanced cancer pain who underwent intrathecal morphine infusion by percutaneous device for treatment of severe cancer pain from April 2017 to April 2018 was included. General information such as pain scores,length of hospitalization and hospitalization costs were collected,effects of intrathecal analgesics on pain intensity,routine living ability and analgesic dosage were evaluated,and changes in analgesic treatment cost before and after intrathecal analgesia,and time period required for equilibrium between daily analgesic cost balance before and after intrathecal analgesia and hospitalization cost were analyzed. RESULTS Patients with cancer pain undergoing intrathecal analgesic operation had an average pain duration of(48 237.0±11 137.0) months,an average length of hospitalization of(13.0±5.8) days and an average hospitalization cost of RMB(48 236.96±11 136.99). Intrathecal analgesics could significantly reduce pain intensity(VAS score: 6.81±0.16 vs. 2.69±0.22),analgesic dosage(105.94±23.04) mg vs.(1.62±0.44) mg and treatment cost [(211.71±99.31) Yuan vs.(5.62±0.15) Yuan],but had no effect on the patients' daily living ability [(68.75±25.84) vs.(65.47±25.09)]. The time period required for equilibrium between daily analgesic cost balance before and after intrathecal analgesia and hospitalization cost was(515.87±325.56) days.CONCLUSION Intrathecal morphine infusion by percutaneous device is an effective method for advanced cancer pain,and can reduce analgesic dosage and daily analgesic cost,but cannot nor daily life quality and reduce total cost for analgesia.
OBJECTIVE To assess the analgesic effect and economics of intrathecal morphine infusion via percutaneous device for treatment of cancer pain.METHODS A total of 32 cases of patients with advanced cancer pain who underwent intrathecal morphine infusion by percutaneous device for treatment of severe cancer pain from April 2017 to April 2018 was included. General information such as pain scores,length of hospitalization and hospitalization costs were collected,effects of intrathecal analgesics on pain intensity,routine living ability and analgesic dosage were evaluated,and changes in analgesic treatment cost before and after intrathecal analgesia,and time period required for equilibrium between daily analgesic cost balance before and after intrathecal analgesia and hospitalization cost were analyzed. RESULTS Patients with cancer pain undergoing intrathecal analgesic operation had an average pain duration of(48 237.0±11 137.0) months,an average length of hospitalization of(13.0±5.8) days and an average hospitalization cost of RMB(48 236.96±11 136.99). Intrathecal analgesics could significantly reduce pain intensity(VAS score: 6.81±0.16 vs. 2.69±0.22),analgesic dosage(105.94±23.04) mg vs.(1.62±0.44) mg and treatment cost [(211.71±99.31) Yuan vs.(5.62±0.15) Yuan],but had no effect on the patients' daily living ability [(68.75±25.84) vs.(65.47±25.09)]. The time period required for equilibrium between daily analgesic cost balance before and after intrathecal analgesia and hospitalization cost was(515.87±325.56) days.CONCLUSION Intrathecal morphine infusion by percutaneous device is an effective method for advanced cancer pain,and can reduce analgesic dosage and daily analgesic cost,but cannot nor daily life quality and reduce total cost for analgesia.
引文
[1] Haumann J,Joosten E,Everdingen M.Pain prevalence in cancer patients:status quo or opportunities for improvement[J].Curr Opin Support Palliat Care,2017,11(2):99-104.
[2] Vayne-Bossert P,Afsharimani B,Good P,et al.Interventional options for the management of refractory cancer pain-what is the evidence[J].Support Care Cancer,2016,24(3):1429-1438.
[3] Mao P,Li CR,Zhu Q,et al.Management of severe cancer pain by intrathecal morphine infusion via subcutaneous port [J].Chin J Pain Med(中国疼痛医学杂志),2016,22 (11):833-837.
[4] Wang WC,Guo XL,Yi ML,et al.Application of evaluation-based therapy strategy in the management of cancer pain by intrathecal morphine pump [J].Chin J Pain Med(中国疼痛医学杂志),2016,22 (9):710-715.
[5] Sun XY,Jiang J,Shi QT,et al.Clinical application of intrathecal analgesia in patients with refractory cancer pain [J].Jiangsu Med J(江苏医药),2016,42(5):567-569.
[6] Suo YY,Zhang LY,Liu LL,et al.Evaluation of the effect of pain evaluation and management informationization in the model ward of cancer pain [J].Guide China Med(中国医药指南),2016,14(27):38-39.
[7] Wang WN,Jia WD,Song KQ,et al.Application of Painless Ward Management Model for Patients with Liver Cancer during Perioperative Period [J].Chin General Pract(中国全科医学),2014,17(27):3256-3260.
[8] Yu SY.Standard for diagnosis and treatment of cancer pain and interpretation of self-evaluation standard for model ward [J].Chin J Pain Med(中国疼痛医学杂志),2012,18(12):706-708.
[9] Wang K,Jin Y.Expert consensus on refractory cancer pain (2017 Edition) [J].Chin J Clin Oncol(中国肿瘤临床),2017,44(16):787-792.
[10] Bruel BM,Burton AW.Intrathecal Therapy for Cancer-Related Pain[J].Pain Med,2016,17(12):2404-2421.
[11] Song L,Lu F,Liu H.Implantation of intrathecal infusion system for intractable cancer pain therapy [J].Chin J Clin Oncol(中国肿瘤临床),2016,43(8):339-343.
[12] Kim EJ,Moon JY,Kim YC,et al.Intrathecal morphine infusion therapy in management of chronic pain:present and future implementation in Korea[J].Yonsei Med J,2016,57(2):475-81.
[13] Xu XW,Li RY.Establishment of hospital intravenous drug use management model based on index system construction [J].China Pharm(中国药师),2017,20(7):1236-1240.
[14] Liu Y,Chen QX,Zhang FJ.Utilization analysis of opioid anlgesics in 39 hospitals in Chongqing during 2013-2015[J].Chin Hosp Pharm J(中国医院药杂志),2018,38(5):533-537.
[15] Bhatia G,Lau ME,Koury KM,et al.Intrathecal drug delivery(ITDD) systems for cancer pain[J].F1000 Res,2014,(2):96.
[2] Vayne-Bossert P,Afsharimani B,Good P,et al.Interventional options for the management of refractory cancer pain-what is the evidence[J].Support Care Cancer,2016,24(3):1429-1438.
[3] Mao P,Li CR,Zhu Q,et al.Management of severe cancer pain by intrathecal morphine infusion via subcutaneous port [J].Chin J Pain Med(中国疼痛医学杂志),2016,22 (11):833-837.
[4] Wang WC,Guo XL,Yi ML,et al.Application of evaluation-based therapy strategy in the management of cancer pain by intrathecal morphine pump [J].Chin J Pain Med(中国疼痛医学杂志),2016,22 (9):710-715.
[5] Sun XY,Jiang J,Shi QT,et al.Clinical application of intrathecal analgesia in patients with refractory cancer pain [J].Jiangsu Med J(江苏医药),2016,42(5):567-569.
[6] Suo YY,Zhang LY,Liu LL,et al.Evaluation of the effect of pain evaluation and management informationization in the model ward of cancer pain [J].Guide China Med(中国医药指南),2016,14(27):38-39.
[7] Wang WN,Jia WD,Song KQ,et al.Application of Painless Ward Management Model for Patients with Liver Cancer during Perioperative Period [J].Chin General Pract(中国全科医学),2014,17(27):3256-3260.
[8] Yu SY.Standard for diagnosis and treatment of cancer pain and interpretation of self-evaluation standard for model ward [J].Chin J Pain Med(中国疼痛医学杂志),2012,18(12):706-708.
[9] Wang K,Jin Y.Expert consensus on refractory cancer pain (2017 Edition) [J].Chin J Clin Oncol(中国肿瘤临床),2017,44(16):787-792.
[10] Bruel BM,Burton AW.Intrathecal Therapy for Cancer-Related Pain[J].Pain Med,2016,17(12):2404-2421.
[11] Song L,Lu F,Liu H.Implantation of intrathecal infusion system for intractable cancer pain therapy [J].Chin J Clin Oncol(中国肿瘤临床),2016,43(8):339-343.
[12] Kim EJ,Moon JY,Kim YC,et al.Intrathecal morphine infusion therapy in management of chronic pain:present and future implementation in Korea[J].Yonsei Med J,2016,57(2):475-81.
[13] Xu XW,Li RY.Establishment of hospital intravenous drug use management model based on index system construction [J].China Pharm(中国药师),2017,20(7):1236-1240.
[14] Liu Y,Chen QX,Zhang FJ.Utilization analysis of opioid anlgesics in 39 hospitals in Chongqing during 2013-2015[J].Chin Hosp Pharm J(中国医院药杂志),2018,38(5):533-537.
[15] Bhatia G,Lau ME,Koury KM,et al.Intrathecal drug delivery(ITDD) systems for cancer pain[J].F1000 Res,2014,(2):96.