Epidural Treatment and Endocrine Response to Pain in Cancer Patients

癌症患者的硬膜外治疗和疼痛的内分泌反应

• 批准号: 62480324
• 负责人: OYAMA Tsutomu
• 金额: $ 2.3万
• 依托单位: University of Hirosaki School of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1987
• 资助国家: 日本
• 起止时间: 1987 至 1988
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-62480324/
• 关键词: continuous epidural infusion; continuous epidural infusion pump; cancer pain; morphine; buprenorphine; 日内変動

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.

我们应用吗啡和丁丙诺啡连续硬膜外输注与计算机化的非卧床药物输送-病人自控镇痛（CADD-PCA^<TM>）在癌症患者。CADD-PCA <TM>@&gt;D1是一种8.9 × 16.0 × 2.3cm、重425 g的微型泵，用于持续和递增输注镇痛药。基础速率是自动输注的，但由医生编程的增量输注由患者根据疼痛程度控制。此外，镇痛剂的基础剂量和增量剂量可由患者自我控制，尽管最大剂量由医生预先编程来限制<TM>。所有患者的血压、心率或呼吸频率均无显著变化。吗啡<TM>组除轻度排尿困难和瘙痒外，无CADD-PCA泵引起的机械故障和并发症。为探讨疼痛对血浆皮质醇和促肾上腺皮质激素（ACTH）昼夜变化的影响，对同一患者在CADD-PCA治疗前和镇痛期间分别于8：00、12：00和16：00采血<TM>。治疗前血浆皮质醇水平波动明显。治疗后皮质醇水平有变小的趋势，但未发现皮质醇和ACTH有明显的昼夜变化。硬膜外持续输注吗啡或丁丙诺啡对癌痛患者血浆皮质醇和ACTH浓度的昼夜变化无明显影响，提示心理因素可能参与其中。

项目成果

Tomoko Takazawa: "Long-term Epidural Morphine Administration with a new Patient-controlled Analgesic System for Cancer Pain" Pain Clinic. 9. 245-248 (1988)

Tomoko Takazawa：“使用新型患者自控镇痛系统长期硬膜外吗啡给药治疗癌性疼痛”疼痛诊所。

馬場祥子: 麻酔.

祥子巴巴：麻醉。

高沢鞆子: ペインクリニック. 9. 245-248 (1988)

高泽智子：疼痛诊所。9. 245-248 (1988)

Tsutomu Oyama: "Continuous Epidural Infusion of Morphine with a Pump for Postoperative Analgesia" Rev. Espanola Anest. Rean.34. 374-377 (1987)

Tsutomu Oyama：“用泵连续硬膜外输注吗啡用于术后镇痛”Rev. Espanola Anest。

Tsutomu Oyama: "Continuous vs. Bolus Epidural Morphine" Acta Anaesthesiologica Scandinavica. 31(Suppl 85). 77-79 (1987)

Tsutomu Oyama：“连续注射与硬膜外吗啡推注”《斯堪的纳维亚麻醉学报》。