Bell Rae F, Eccleston Christopher, Kalso Eija
Pain Clinic, Department of Anesthesia and Intensive Care, Haukeland University Hospital, 5021 Bergen, Norway.
J Pain Symptom Manage. 2003 Sep;26(3):867-75. doi: 10.1016/s0885-3924(03)00311-7.
Ketamine is increasingly being used as an adjuvant to opioids in the treatment of refractory cancer pain. This systematic review examines the available evidence. Randomized, controlled trials, with or without crossover, were included. Studies were identified from MEDLINE, EMBASE, CANCERLIT, the Cochrane Library, handsearched reference lists from review articles and chapters from standard textbooks on pain and palliative care and reference lists from papers retrieved. Four randomized, controlled studies were identified. Two were excluded due to poor quality. Both included studies concluded that ketamine improves morphine treatment in cancer pain. Quantitative meta-analysis was not possible. The available evidence is not sufficient to conclude that ketamine improves the effectiveness of opioid treatment in cancer pain. High quality, randomized, controlled trials with larger numbers of patients and standardized, clinically relevant routes of administration of ketamine are needed.
氯胺酮越来越多地被用作阿片类药物的辅助药物，用于治疗难治性癌症疼痛。本系统评价对现有证据进行了审查。纳入了有或无交叉设计的随机对照试验。通过MEDLINE、EMBASE、CANCERLIT、Cochrane图书馆检索研究，并手工检索综述文章的参考文献列表、疼痛与姑息治疗标准教科书的章节以及检索到的论文的参考文献列表。共识别出四项随机对照研究。两项因质量差而被排除。纳入研究均得出结论，氯胺酮可改善癌症疼痛的吗啡治疗效果。无法进行定量荟萃分析。现有证据不足以得出氯胺酮可提高阿片类药物治疗癌症疼痛有效性的结论。需要开展高质量、随机对照试验，纳入更多患者，并采用标准化、具有临床相关性的氯胺酮给药途径。
