Mazzocato C, Buclin T, Rapin C H
Division of Palliative Care, University Hospital, Lausanne, Switzerland.
Ann Oncol. 1999 Dec;10(12):1511-4. doi: 10.1023/a:1008337624200.
Dyspnea represents a very frequent and distressing symptom in patients with advanced cancer. This study was undertaken to assess the efficacy of morphine on dyspnea and its safety for ventilatory function in elderly advanced cancer patients.
Nine elderly patients with dyspnea due to lung involvement were randomized to receive either morphine subcutaneously (5 mg in seven opioid-naïve patients and 3.75 mg in two patients on top of their regular oral dose of 7.5 mg q4 h) or placebo on day 1. On day 2, they were crossed over to receive the alternate treatment. Dyspnea was assessed every fifteen minutes using a visual analogue scale (VAS: 0-100 mm) and the ordinal scale developed by Borg (0-10 points). Pain, somnolence and anxiety were assessed using VAS. Respiratory effort, respiratory rate and oxygen saturation were also measured repeatedly.
Mean changes in dyspnea 45 minutes after injection were -25 +/- 10 mm and -1.2 +/- 1.2 points for morphine, versus 0.6 +/- 7.7 mm (P < 0.01) and -0.1 +/- 0.3 points (P = 0.03) for placebo on VAS and Borg scale, respectively. No relevant changes were observed in somnolence, pain, anxiety, respiratory effort and rate, and oxygen saturation.
Morphine appears effective for cancer dyspnea, and it does not compromise respiratory function at the dose level used.
呼吸困难是晚期癌症患者非常常见且令人痛苦的症状。本研究旨在评估吗啡对老年晚期癌症患者呼吸困难的疗效及其对通气功能的安全性。
9名因肺部受累而出现呼吸困难的老年患者在第1天被随机分为皮下注射吗啡组（7名未使用过阿片类药物的患者注射5毫克，2名正在接受每4小时7.5毫克常规口服剂量的患者在此基础上再注射3.75毫克）或安慰剂组。在第2天，他们交叉接受替代治疗。每15分钟使用视觉模拟量表（VAS：0 - 100毫米）和Borg制定的序数量表（0 - 10分）评估呼吸困难情况。使用VAS评估疼痛、嗜睡和焦虑情况。还反复测量呼吸努力程度、呼吸频率和血氧饱和度。
注射后45分钟，吗啡组呼吸困难的平均变化在VAS量表上为 - 25±10毫米，在Borg量表上为 - 1.2±1.2分；而安慰剂组在VAS量表上为0.6±7.7毫米（P < 0.01），在Borg量表上为 - 0.1±0.3分（P = 0.03）。在嗜睡、疼痛、焦虑、呼吸努力程度和频率以及血氧饱和度方面未观察到相关变化。
吗啡似乎对癌症引起的呼吸困难有效，并且在所使用的剂量水平下不会损害呼吸功能。
