Abernethy Amy P, Currow David C, Frith Peter, Fazekas Belinda S, McHugh Annie, Bui Chuong
Department of Palliative and Supportive Services, Division of Medicine, Flinders University of South Australia, Bedford Park, South Australia 5042, Australia.
BMJ. 2003 Sep 6;327(7414):523-8. doi: 10.1136/bmj.327.7414.523.
To determine the efficacy of oral morphine in relieving the sensation of breathlessness in patients in whom the underlying aetiology is maximally treated.
Randomised, double blind, placebo controlled crossover study.
Four outpatient clinics at a hospital in South Australia.
48 participants who had not previously been treated with opioids (mean age 76, SD 5) with predominantly chronic obstructive pulmonary disease (42, 88%) were randomised to four days of 20 mg oral morphine with sustained release followed by four days of identically formulated placebo, or vice versa. Laxatives were provided as needed.
Dyspnoea in the morning and evening as shown on a 100 mm visual analogue scale, quality of sleep, wellbeing, performance on physical exertion, and side effects as measured at the end of the four day treatment period.
38 participants completed the study; three withdrew because of definite and two because of possible side effects of morphine (nausea, vomiting, and sedation). Participants reported significantly different dyspnoea scores when treated with morphine: an improvement of 6.6 mm (95% confidence interval 1.6 mm to 11.6 mm) in the morning and of 9.5 mm (3.0 mm to 16.1 mm) in the evening (P = 0.011 and P = 0.006, respectively). During the period in which they were taking morphine participants also reported better sleep (P = 0.039). More participants reported distressing constipation while taking morphine (9 v 1, P = 0.021) in spite of using laxatives. All other side effects were not significantly worse with morphine, although the study was not powered to address side effects.
Sustained release, oral morphine at low dosage provides significant symptomatic improvement in refractory dyspnoea in the community setting.
确定在潜在病因已得到最大程度治疗的患者中，口服吗啡缓解呼吸困难感觉的疗效。
随机、双盲、安慰剂对照交叉研究。
南澳大利亚一家医院的四个门诊诊所。
48名未曾接受过阿片类药物治疗的参与者（平均年龄76岁，标准差5），主要患有慢性阻塞性肺疾病（42例，88%），被随机分为接受4天20毫克缓释口服吗啡治疗，随后4天接受相同配方的安慰剂治疗，或反之。根据需要提供泻药。
在为期4天的治疗期结束时，通过100毫米视觉模拟量表显示的早晚呼吸困难情况、睡眠质量、健康状况、体力活动表现以及副作用。
38名参与者完成了研究；3名因明确的副作用、2名因可能的吗啡副作用（恶心、呕吐和镇静）退出。参与者在接受吗啡治疗时报告的呼吸困难评分有显著差异：早晨改善6.6毫米（95%置信区间1.6毫米至11.6毫米），晚上改善9.5毫米（3.0毫米至16.1毫米）（分别为P = 0.011和P = 0.006）。在服用吗啡期间，参与者还报告睡眠更好（P = 0.039）。尽管使用了泻药，但更多参与者在服用吗啡时报告有令人痛苦的便秘（9例对1例，P = 0.021）。所有其他副作用在使用吗啡时并没有明显更严重，尽管该研究没有足够的能力来研究副作用。
低剂量缓释口服吗啡可在社区环境中显著改善难治性呼吸困难症状。
