Elsner F, Sabatowski R, Radbruch L
Klinik und Poliklinik für Anaesthesiologie und Operative Intensivmedizin, Universität Köln.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2000 Jul;35(7):462-4. doi: 10.1055/s-2000-5941.
Even when the guidelines for cancer pain management are followed, acute severe pain requiring immediate treatment will occur in some patients. Titration with intravenous morphine may provide fast and efficient pain relief and give an indication of the amount of opioid necessary for continuous treatment. In cooperation with a general practitioner we performed an intravenous morphine titration in a patient with severe cancer pain at home. Adequate analgesia was reached with 20 mg intravenous morphine. Blood pressure, cardiac frequency and oxygen saturation did not change. No side effects were reported during the titration, and the previous regimen with tramadol 150 mg per day was switched to slow release morphine 300 mg per day. This medication was prescribed by the general practitioner and provided good pain relief until the patient died two weeks later. We conclude that intravenous morphine titration may be performed even in cancer patients at home, adequate monitoring, however, should be available.
即使遵循癌症疼痛管理指南，一些患者仍会出现需要立即治疗的急性重度疼痛。静脉注射吗啡进行滴定可快速有效地缓解疼痛，并能提示持续治疗所需的阿片类药物剂量。我们与一名全科医生合作，在家中对一名患有重度癌症疼痛的患者进行了静脉注射吗啡滴定。静脉注射20毫克吗啡后达到了充分镇痛效果。血压、心率和血氧饱和度均未改变。滴定过程中未报告副作用，之前每天服用150毫克曲马多的方案改为每天服用300毫克缓释吗啡。此药物由全科医生开出处方，在患者两周后去世前一直提供良好的疼痛缓解效果。我们得出结论，即使是在家中的癌症患者也可进行静脉注射吗啡滴定，不过应具备充分的监测条件。
