Epidural Treatment and Endocrine Response to Pain in Cancer Patients

我们在癌症患者中应用了吗啡和丁丙诺啡持续硬膜外输注和电脑非卧床给药-患者自控镇痛(CADD-PCA)。我们评估了CADD-PCA的有效性和安全性，并研究了疼痛和疼痛缓解对血浆应激激素水平的影响。CADD-PCA@&gt；D1TM@&gt；D1是一种8.9x16.0x2.3 cm的配置泵，重425g，用于持续和增量输注止痛药。基础输液率是自动输注的，但由医生编程的增量输液由患者根据疼痛的大小进行控制。此外，止痛药的基础剂量和增量剂量可由患者自行控制，尽管最大剂量由医生提前编程限制。16例癌症患者使用CADD-PCA^&lt；TM&gt；使用盐酸吗啡，5例患者使用丁丙诺啡。所有患者的血压、心率和呼吸频率均无明显变化。除吗啡组有轻度排尿困难和瘙痒外，未见CADD-PCA泵引起的机械故障和并发症。为了检测疼痛对血浆皮质醇和促肾上腺皮质激素的日变化的影响，在CADD-PCA治疗前和止痛期分别于8：00、12：00和16：00采集同一患者的血样。治疗前血浆皮质醇水平波动明显。治疗后皮质醇水平有下降趋势，但皮质醇和ACTH未见明显的日变化。提示肿瘤患者硬膜外持续输注丁丙诺啡的镇痛作用不影响血浆皮质醇和ACTH水平的昼夜变化，提示心理因素可能参与其中。

We have applied morphine and buprenorphine by continuous epidural infusion with computerized ambulatory drug delivery-patient-controlled analgesia (CADD-PCA^<TM>) in cancer patients. We evaluated the efficacy and safety of CADD-PCA^<TM> and studied the effect of pain and pain relief on plasma levels of stress hormones.CADD-PCA@>D1TM@>D1 is a compuct pump of 8.9 x 16.0 x 2.3 cm, weighing 425g, for continuous and incremental infusion of analgesics. The basal rate is infused automatically, but incremental infusion programmed by a physician is controlled by the patient depending upon the magnitude of pain. In addition, the basal and incremental dose of analgesic can be self-controlled by a patient, although the maximum dose is limited by programming in advance by the physician.Morphine hcl by using CADD-PCA^<TM> was administered to 16 cancer patients and buprenorphine was used in 5 patients. No significant changes in blood pressure, heart rate or respiratory rate were observed in all patients. Neither mechanical trouble caused by CADD-PCA^<TM> pump nor complication except for slight dysuria and itching in morphine group was experienced. The device was proved to be safe and useful for epidural infusion of analgesics.To detect the influence of pain on the diurnal variation of plasma levels of cortisol and ACTH, the blood samples were obtained at 8:00, 12:00 ＆ 16:00 from the same patient before the treatment with CADD-PCA^<TM> and during the pain relief period. Plasma levels of cortisol before treatment fluctuated markedly. After the treatment the cortisol levels had a tendency of less variable, but we could not find any clear diurnal variation of cortisol and ACTH. It is thus suggested that psychological factor might participate in it, because diurnal variation of plasma levels of cortisol and ACTH was not influenced by the analgesic effect of continuous epidural infusion of morphine of buprenorphine in cancer patients.