Mercadante S, Ripamonti C, Casuccio A, Zecca E, Groff L
Pain Relief and Palliative Care, SAMOT, Palermo, Italy.
Support Care Cancer. 2000 May;8(3):188-91. doi: 10.1007/s005200050283.
In advanced cancer patients with inoperable bowel obstruction, the administration of antisecretive and antiemetic drugs has proved to be effective in controlling gastrointestinal symptoms caused by bowel obstruction. However, controlled studies concerning the most effective antisecretive drug are lacking. The aim of this randomized controlled study was to determine whether octreotide or hyoscine butylbromide was the more effective antisecretive drug for use in states of inoperable bowel obstruction. Eighteen patients with inoperable bowel obstruction randomly received octreotide 0.3 mg daily (n = 9) or hyoscine butylbromide (HB) 60 mg daily (n = 9) s.c. The following parameters were measured: episodes of vomiting, nausea, drowsiness, continuous and colicky pain, using a Likert scale corresponding to a numerical value: (none 0, slight 1, moderate 2, severe 3) recorded before starting the treatment (T0) and 24 h (T1), 48 h (T2) and 72 h after (T3), and the mean daily amounts of fluids administered i.v. or s.c. during the period of study. Three patients dropped out of the study because data were incomplete. Octreotide treatment induced a significantly rapid reduction in the number of daily episodes of vomiting and intensity of nausea compared with HB treatment at the different time intervals examined. No relevant changes were found in dry mouth, drowsiness and colicky pain. Lower levels of hydration were associated with nausea regardless of the treatment. At the doses used in this study, octreotide was more effective than HB in controlling gastrointestinal symptoms of bowel obstruction. Further studies are necessary to understand the role of hydration more clearly in such a clinical situation.
在患有无法手术的肠梗阻的晚期癌症患者中，使用抗分泌和抗呕吐药物已被证明对控制肠梗阻引起的胃肠道症状有效。然而，缺乏关于最有效的抗分泌药物的对照研究。这项随机对照研究的目的是确定奥曲肽或丁溴东莨菪碱在无法手术的肠梗阻状态下是否为更有效的抗分泌药物。18例无法手术的肠梗阻患者随机接受每日皮下注射0.3mg奥曲肽（n = 9）或每日皮下注射60mg丁溴东莨菪碱（HB）（n = 9）。测量以下参数：呕吐、恶心、嗜睡、持续性和绞痛性疼痛的发作情况，使用对应数值的李克特量表：（无0，轻微1，中度2，重度3）在开始治疗前（T0）以及治疗后24小时（T1）、48小时（T2）和72小时（T3）记录，以及研究期间静脉内或皮下注射的平均每日液体量。3名患者因数据不完整退出研究。在不同检查时间间隔，与HB治疗相比，奥曲肽治疗使每日呕吐发作次数和恶心强度显著快速降低。口干、嗜睡和绞痛性疼痛未发现相关变化。无论治疗如何，较低的水合水平与恶心相关。在本研究使用的剂量下，奥曲肽在控制肠梗阻的胃肠道症状方面比HB更有效。有必要进行进一步研究以更清楚地了解水合作用在这种临床情况下的作用。
