O'Mahony S, Coyle N, Payne R
Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Oncology (Williston Park). 2001 Jan;15(1):61-73, 77; discussion 77-8, 80-2.
The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient's age, the presence of coexistent renal and hepatic disease, pulmonary disease, and cognitive dysfunction, a prior opioid history, use of polypharmacy, dose of opioid drug being administered, and the route of administration. The most common opioid-related side effects are constipation, sedation, nausea, vomiting, and cognitive disturbance. Less frequent side effects include urinary retention, perceptual distortion, respiratory depression, and myoclonus. In an era emphasizing quality of life in cancer care, clinicians need to be aware of (1) factors that influence the prevalence of opioid-related side effects, (2) effective management strategies, and (3) how to recognize when symptoms are opioid related as opposed to caused by other etiologies, such as the patient's disease process or treatment approaches. The use of validated instruments and repeated assessment enhances such an evaluation and subsequent treatment. This article delineates the current optimal management of opioid-related nausea and vomiting, constipation, cognitive side effects, myoclonus, and respiratory depression.
由于缺乏对管理策略的比较研究，阿片类药物相关副作用的最佳管理受到阻碍。此类副作用的发生率受疾病程度、患者年龄、是否存在并存的肾和肝疾病、肺部疾病、认知功能障碍、既往阿片类药物使用史、联合用药情况、所使用阿片类药物的剂量以及给药途径的影响。最常见的阿片类药物相关副作用是便秘、镇静、恶心、呕吐和认知障碍。较不常见的副作用包括尿潴留、感知扭曲、呼吸抑制和肌阵挛。在一个强调癌症护理生活质量的时代，临床医生需要了解：（1）影响阿片类药物相关副作用发生率的因素；（2）有效的管理策略；（3）如何识别症状是与阿片类药物相关，而非由其他病因引起，如患者的疾病进程或治疗方法。使用经过验证的工具和重复评估可加强此类评估及后续治疗。本文阐述了当前阿片类药物相关恶心和呕吐、便秘、认知副作用、肌阵挛及呼吸抑制的最佳管理方法。
