Bruera E, Neumann C M, Pituskin E, Calder K, Hanson J
University of Texas, M. D. Anderson Cancer Center, Houston, USA.
Ann Oncol. 1999 Oct;10(10):1255-8. doi: 10.1023/a:1008331727535.
Most cancer patients develop reduced oral intake or dehydration before death. Subcutaneous hydration (SCH) can be safe and effective. SCH is frequently administered using hyaluronidase to improve fluid absorption. The objective of this study was to determine the effects of hyaluronidase on patient comfort during bolus SCH.
Twenty-one cancer patients requiring parenteral hydration were administered a 500 cc bolus of two-thirds dextrose (5%) and one-third normal saline solution subcutaneously at 08:00 and 16:00 hours during day 1 and day 2. On day 1 patients were randomized on a double-blind basis to receive 150 units of hyaluronidase versus placebo as a bolus into the site of infusion immediately before starting each one-hour infusion. During day 2 patients were crossed over to receive the alternate treatment at a new infusion site. Visual analogue scales (0 = best, 100 = worst) for pain and swelling at the infusion site were completed by each patient. In addition, investigators blindly assessed the site of infusion for the presence of edema, rash, and leakage.
No significant differences were observed for pain, swelling, edema, rash or leakage between the placebo and the hyaluronidase scores. After completion of the two days of the study, patients blindly chose hyaluronidase in 1 (5%) case, placebo in 5 (24%) cases, and no preference in 15 (71%) cases (P < 0.01). There was no treatment or interaction effect for pain, except for a period effect (P = 0.045) for the morning bolus administration. There were no treatment, period, or interaction effects for any of the other variables.
Our results suggest that hyaluronidase is not necessary for routine bolus SCH. It may still be useful for a minority of patients who are not able to tolerate infusion well due to swelling or pain.
大多数癌症患者在死亡前会出现经口摄入量减少或脱水的情况。皮下补液（SCH）可能既安全又有效。皮下补液通常会使用透明质酸酶来提高液体吸收效果。本研究的目的是确定透明质酸酶在推注式皮下补液过程中对患者舒适度的影响。
21名需要肠外补液的癌症患者在第1天和第2天的08:00和16:00接受皮下注射500毫升含三分之二葡萄糖（5%）和三分之一生理盐水的溶液。在第1天，患者以双盲方式随机分组，在每次一小时输液开始前立即在输液部位推注150单位透明质酸酶或安慰剂。在第2天，患者交叉至新的输液部位接受另一种治疗。每位患者完成关于输液部位疼痛和肿胀的视觉模拟量表（0分表示最佳，100分表示最差）。此外，研究人员对输液部位进行盲法评估，查看是否存在水肿、皮疹和渗漏情况。
安慰剂组和透明质酸酶组在疼痛、肿胀、水肿、皮疹或渗漏方面的评分无显著差异。在完成为期两天的研究后，患者盲目选择透明质酸酶的有1例（5%），选择安慰剂的有5例（24%），无偏好的有15例（71%）（P < 0.01）。除了早晨推注给药存在时段效应（P = 0.045）外，疼痛方面没有治疗或交互作用效应。其他任何变量均无治疗、时段或交互作用效应。
我们的研究结果表明，常规推注式皮下补液无需使用透明质酸酶。对于少数因肿胀或疼痛而无法耐受输液的患者，它可能仍然有用。
