Bruera Eduardo, Macmillan Karen, Kuehn Norma, Miller Melvin J
Palliative Care Program, Edmonton General Hospital, Edmonton, Alberta T5K 0L4 Canada.
Pain. 1992 Jun;49(3):311-314. doi: 10.1016/0304-3959(92)90236-5.
In this open study we reviewed the circadian distribution of extra doses of narcotic analgesics in 61 bed-ridden patients with cancer pain. The information was collected prospectively and retrospectively in 34 and 27 cases, respectively. All patients were receiving parenteral narcotics using the Edmonton Injector, and none had incidental pain or cognitive impairment. A total of 1322 extra doses of narcotics (each dose = 10% of the daily dose) were administered during 610 patient days (average of 2.17 +/- 1.6 doses/patient/day). The mean daily number of extra doses during each interval was as follows: 02.00-06.00 h (0.24 +/- 0.27), 06.00-10.00 h (0.26 +/- 0.31), 10.00-14.00 h (0.43 +/- 0.44), 14.00-18.00 h (0.44 +/- 0.41), 18.00-22.00 h (0.40 +/- 0.36), and 22.00-02.00 h (0.40 +/- 0.36) (02.00-06.00 h and 06.00-10.00 h vs. 10.00-02.00 h: P less than 0.01). Forty-five of 61 patients (76%) received most of their extra doses of narcotics between 10.00 and 22.00 h. The data suggest that our patients require a larger number of extra doses during day time. Our design cannot establish the reason for this circadian variation.
在这项开放性研究中，我们回顾了61例卧床癌症疼痛患者额外剂量麻醉性镇痛药的昼夜分布情况。分别前瞻性收集了34例患者和回顾性收集了27例患者的信息。所有患者均使用埃德蒙顿注射器接受胃肠外麻醉药治疗，且均无偶发性疼痛或认知障碍。在610个患者日期间共给予了1322剂额外剂量的麻醉药（每剂 = 日剂量的10%）（平均2.17±1.6剂/患者/天）。每个时间段额外剂量的平均每日数量如下：02:00 - 06:00时（0.24±0.27），06:00 - 10:00时（0.26±0.31），10:00 - 14:00时（0.43±0.44），14:00 - 18:00时（0.44±0.41），18:00 - 22:00时（0.40±0.36），以及22:00 - 02:00时（0.40±0.36）（02:00 - 06:00时和06:00 - 10:00时与10:00 - 02:00时相比：P < 0.01）。61例患者中有45例（76%）在10:00至22:00时期间接受了大部分额外剂量的麻醉药。数据表明我们的患者在白天需要更多额外剂量。我们的设计无法确定这种昼夜变化的原因。
