Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin
Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin
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DOI：
10.1046/j.1525-1403.2002._2004.x
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发表时间：
2002-01-01
期刊：
影响因子：
2.8
通讯作者：
Spatz, EL
中科院分区：
文献类型：
--
作者：
Ordia, JI;Fischer, E;Spatz, EL
本研究旨在确定通过程控泵鞘内注射巴氯芬（ITB）治疗脊髓源性重度痉挛的有效性和安全性，对152例脊髓源性重度痉挛、口服巴氯芬难治性或出现不可耐受副作用的患者给予试验剂量的ITB。只有那些反应令人满意的患者才被认为适合植入泵。152名患者中除1名患者外，其余患者均获得了满意的反应，131名患者植入了泵。对比和分析术前和术后痉挛评分，ITB时强直的平均Ashworth评分从术前的4.2降至1.3（p < 0.0005）。痉挛评分从平均3.4降至0.6（p < 0.0005）。痉挛的减少导致身体活动水平的提高，疼痛的减少和睡眠的增加。药物相关并发症包括便秘、肌张力减退、尿潴留、勃起功能障碍、恶心、头晕、嗜睡、低血压和心动过缓以及对巴氯芬的耐受性。一些患者出现脊椎穿刺后头痛。导管相关问题包括闭塞、断裂、穿刺和移位。浅表泵囊袋感染、囊袋糜烂、脑脊液（CSF）漏、脊柱穿刺后头痛和脑膜炎是一些手术相关并发症。两个泵翻转，另一个泵阀卡住。我们得出结论，通过植入程控泵长期鞘内注射巴氯芬是治疗严重顽固性脊髓痉挛的安全有效的方法。
We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin.One hundred fifty two patients with severe spasticity of spinal origin, refractory to oral baclofen, or who experienced intolerable side-effects were given a test dose of ITB. Only those who had a satisfactory response were considered to be appropriate for pump implantation. All but one of the 152 patients had a satisfactory response, and the pump was implanted in 131 patients. Pre- and postoperative spasticity scores were compared and analyzed.The mean Ashworth score for rigidity decreased from 4.2 preoperatively to 1.3 (p < 0.0005) on ITB. The spasm score decreased from a mean of 3.4 to 0.6 (p < 0.0005). Reduction of spasticity resulted in improved levels of physical activity, decreased pain, and augmentation of sleep. Drug-related complications included constipation, muscular hypotonia, urinary retention, erectile dysfunction, nausea, dizziness, drowsiness, hypotension and bradycardia as well as tolerance to baclofen. Some patients experienced post-spinal puncture headaches. Catheter-related problems included occlusions, breaks, punctures, and dislodgments. Superficial pump pocket infection, pocket erosion, cerebrospinal fluid (CSF) leak, post-spinal puncture headache, and meningitis were some of the procedure-related complications. Two pumps flipped and another pump valve was stuck.We conclude that long-term Intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe Intractable spinal spasticity.