Morita Tatsuya, Takigawa Chizuko, Onishi Hideki, Tajima Tsukasa, Tani Kazuhiko, Matsubara Tatsuhiko, Miyoshi Izuru, Ikenaga Masayuki, Akechi Tatsuo, Uchitomi Yosuke
Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu, Shizuoka, Japan.
J Pain Symptom Manage. 2005 Jul;30(1):96-103. doi: 10.1016/j.jpainsymman.2004.12.010.
Although recent studies suggest that opioid rotation could be an effective treatment strategy for morphine-induced delirium, there have been no prospective studies to investigate the treatment effects of opioid rotation using fentanyl. The primary aim of this study was to clarify the efficacy of opioid rotation from morphine to fentanyl in symptom palliation of morphine-induced delirium. Twenty-one consecutive cancer patients with morphine-induced delirium underwent opioid rotation to fentanyl. Physicians recorded the symptom severity of delirium (the Memorial Delirium Assessment Scale, MDAS), pain, and other symptoms (categorical verbal scale from 0: none to 3: severe) and the Schedule for Team Assessment Scale (STAS) (from 0: none to 4: extreme); and performance status at the time of study enrollment and three and seven days after. Of 21 patients recruited, one patient did not complete the study. In the remaining 20 patients, morphine was substituted with transdermal fentanyl in 9 patients and parenteral fentanyl in 11 patients. Total opioid dose increased from 64 mg oral morphine equivalent/day (Day 0) to 98 mg/day (Day 7), and the median increase in total opioid dose was 42%. Treatment success, defined as an MDAS score below 10 and pain score of 2 or less, was obtained in 13 patients on Day 3 and 18 patients on Day 7. The mean MDAS score significantly decreased from 14 (Day 0) to 6.4 and 3.6 (Days 3 and 7, respectively, P < 0.001). Pain scores significantly decreased from 2.2 (Day 0) to 1.3 and 1.1 on the categorical verbal scale (Days 3 and 7, respectively, P < 0.001); from 2.6 (Day 0) to 1.6 and 1.3 on the STAS (Days 3 and 7, respectively, P < 0.001). Symptom scores of dry mouth, nausea, and vomiting significantly decreased, and performance status significantly improved. Opioid rotation from morphine to fentanyl may be effective in alleviating delirium and pain in cancer patients with morphine-induced delirium.
尽管最近的研究表明，阿片类药物轮换可能是治疗吗啡诱发谵妄的有效策略，但尚无前瞻性研究调查使用芬太尼进行阿片类药物轮换的治疗效果。本研究的主要目的是阐明从吗啡转换为芬太尼的阿片类药物轮换在缓解吗啡诱发谵妄症状方面的疗效。21例连续的患有吗啡诱发谵妄的癌症患者接受了阿片类药物向芬太尼的轮换。医生记录了谵妄的症状严重程度（纪念性谵妄评估量表，MDAS）、疼痛及其他症状（分类语言量表，从0：无到3：严重）以及团队评估量表（STAS）（从0：无到4：极度）；并记录了研究入组时以及入组后3天和7天的体能状态。在招募的21例患者中，1例患者未完成研究。在其余20例患者中，9例患者将吗啡替换为透皮芬太尼，11例患者替换为胃肠外芬太尼。阿片类药物总剂量从64毫克口服吗啡当量/天（第0天）增加到98毫克/天（第7天），阿片类药物总剂量的中位数增加了42%。治疗成功定义为MDAS评分低于10且疼痛评分为2或更低，第3天有13例患者获得成功，第7天有18例患者获得成功。MDAS平均评分从14（第0天）显著降至6.4和3.6（分别为第3天和第7天，P<0.001）。疼痛评分在分类语言量表上从2.2（第0天）显著降至1.3和1.1（分别为第3天和第7天，P<0.001）；在STAS上从2.6（第0天）降至1.6和1.3（分别为第3天和第7天，P<0.001）。口干、恶心和呕吐的症状评分显著降低，体能状态显著改善。从吗啡转换为芬太尼的阿片类药物轮换可能有效缓解患有吗啡诱发谵妄的癌症患者的谵妄和疼痛。
