Clinical Research Of The Efficacy Of Patient Controlled Intrathecal Hydromorphone Infusion In The Treatment Of Refractory Cancer Pain And The Effect On Immune Status Of Patients

Objective: To observe the clinical efficacy of patient controlled intathercal hydromorphone infusion in the treatment of refractory cancer pain compared with oral morphine.Methods: Forty patients who were admitted for treatment of severe cancer pain from January 2016 to December 2016 in our department.Routine therapy of oral morphine?dosage>200mg/d?has no enough efficiency?VAS>5?on these patients who's overall survival would more than one month.Made a perfect assessment on patients including the level of awareness,cardio-pulmonary function,liver and renal function,coagulative function,CT or MRI examination etc in order to rule out surgical contraindications and make sure there is no difficulty on lumbar puncture.Then implanted the intrathecal infusion system in operation room under the the guidance of C arm X-ray machine.Fixed the position of the L3/4 intervertebral space and placed the intrathecal catheter system in the proper position of pain under the guidance of the C arm X-ray machine avoid the catheter overbend,then made a sac to bury the implantable port-cath at the junction of hypochondrium axillary midline,after that built a subcutaneous cableway from the puncture point to the port-cath,connected the end of the catheter with the port-cath,then used a butterfly needle to connect the PCA pump with the port-cath.Stopped the oral medicines when initiating continuous intrathecal infusion therapy.Pain VAS scores,the cell counts of T lymphocyte subsets CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺ and NK cells were recorded at the time of before intrathecal infusion therapy?T₀?,one day after intrathecal infusion?T₁?,one week after intrathecal infusion?T₂?;SF-36 scores,SDS scores were recorded at the time of before intrathecal infusion therapy?T₀?,one week after intrathecal infusion?T₂?;The incidence of constipation,nausea and vomiting were recorded before?T₀?and one week after intrathecal infusion?T₂?.Use SPSS19.0 for data analysis.Measurement data of the research were described as Mean ± SD?x ±s?and were compared using independent-sample t-test.Count data were compared Using chi-square test.P?0.05 had significant difference.Result: All cancer pain patients of this study were completed intrathecal infusion port-cath implantation and were completed clinical follow-up during the overall survival.All data were enrolled in the statistical analysis.The VAS scores of all of the patients at T₁,T₂ compared with T₀ were lower than T₀?P<0.01?;The SF36 scores of all of the patients at T₂ compared with T₀ were higher than T₀?P<0.01?;The SDS scores of all of the patients at T₂ compared with T₀ were higher than T₀?P<0.01?;The T lymphocyte subsets CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺and NK cells at T₁ compared with T₀ were lower than T₀?P<0.05?;The T lymphocyte subsets CD3⁺,CD4⁺,CD8⁺,CD4⁺/CD8⁺and NK cells at T₂ compared with T₀ were higher than T₀?P<0.05?;The incidence of constipation,nausea and vomiting T₂ compared with T₀ were lower than T₀?P<0.01?;In this study the case number of urinary retention were 3 cases,the case number of headache were 2 cases,and all of these cases took a turn for better within 3 days.Conclusion: Patient controlled intrathecal hydromorphone infusion compared with oral morphine can significantly reduce the cancer pain,and improve the patient's quality of life,immune status and depression state.It also can reduce the incidence of constipation,nausea and vomiting.