曹峰

摘 要 目的：调查光动力治疗（photodynamic therapy，PDT）过程中疼痛的相关影响因素，以及缓解疼痛的有效方法。方法：在PubMed数据库中检索PDT过程中疼痛的临床研究文献，并对数据进行总结。结果：治疗过程中的疼痛是PDT最常见的不良反应。与疼痛相关的因素包括光敏剂类型、病损部位和大小、辐照剂量、光源类型和波长等。多种疼痛缓解对策已经被研究，大多数研究显示，外用局麻药物对缓解PDT疼痛无效。对治疗部位冷却能部分缓解PDT疼痛，但效果是不充分的。神经阻滞可以有效地缓解PDT疼痛。结论：治疗部位冷却是缓解PDT疼痛，提高患者耐受度最简单、最经济的方法，作为临床优先方案被推荐使用。对于简单冷却效果不佳的患者，可以选择神经阻滞来有效控制PDT过程中的疼痛。

关键词 光动力治疗 疼痛 缓解

中图分类号：R459.9 文献标识码：A 文章编号：1006-1533（2016）13-0062-04

Pain during photodynamic therapy and its relief strategies*

CAO Feng**

（Shanghai Fudan-Zhangjiang Bio-Pharmaceutical Co. Ltd.， Shanghai 201210， China）

ABSTRACT Objective： To investigate the factors of pain associated with photodynamic therapy （PDT） and find the effective methods for relieving the pain during treatment. Methods： The literature on the clinical research of pain resulting from PDT was thoroughly searched for by PubMed and the published data were summarized. Results： The pain during PDT is the most commonly reported adverse effect. Various factors influencing pain include the type of photosensitizer， the site and size of lesion， irradiation dose， light source and wavelength. Numerous strategies for relieving pain during PDT have been studied. The most studies showed that topical anesthetics had no benefit to relieving the pain from PDT. Cooling the site of PDT treatment could partially relief the pain but the efficacy was insufficient. Nerve blocks could efficiently relief the pain during PDT. Conclusion： Cooling the site during illumination is an easy and inexpensive way to make PDT treatment more tolerable for the patient and has been recommended as a priority scheme to be used in clinic. For rare cases in which cooling simply fails to control the pain， nerve block can be adopted.

KEY WORDS photodynamic therapy； pain； relief

光动力治疗（photodynamic therapy，PDT）是20世纪80年代开始的一项新型临床诊疗技术，该技术利用光敏药物和特定波长光源设备的联合作用，对肿瘤、血管性疾病等局部病灶实施靶向治疗，现临床广泛应用于体表某些非黑色素皮肤癌的非侵入性治疗，其有效性、安全性及治疗后的美容效果被充分认可。PDT的主要不良反应是治疗过程中的疼痛感，接受治疗的大部分患者均报告了疼痛的不良反应，个别患者甚至因为难以忍受疼痛而中断或放弃采用PDT治疗。本文就已发表的相关临床实践进行综述，以期寻找有效且具可操作性的PDT过程中疼痛的缓解对策。……