Swegle John M, Logemann Craig
Mercy Family Medicine Residency Program, Mason City, Iowa 50401-2859, USA.
Am Fam Physician. 2006 Oct 15;74(8):1347-54.
Opioid analgesics are useful agents for treating pain of various etiologies; however, adverse effects are potential limitations to their use. Strategies to minimize adverse effects of opioids include dose reduction, symptomatic management, opioid rotation, and changing the route of administration. Nausea occurs in approximately 25 percent of patients; prophylactic measures may not be required. Patients who do develop nausea will require antiemetic treatment with an antipsychotic, prokinetic agent, or serotonin antagonist. Understanding the mechanism for opioid-induced nausea will aid in the selection of appropriate agents. Constipation is considered an expected side effect with chronic opioid use. Physicians should minimize the development of constipation using prophylactic measures. Monotherapy with stool softeners often is not effective; a stool softener combined with a stimulant laxative is preferred. Sedation and cognitive changes occur with initiation of therapy or dose escalation. Underlying disease states or other centrally acting medications often will compound the opioid's adverse effects. Minimizing unnecessary medications and judicious use of stimulants and antipsychotics are used to manage the central nervous system side effects. Pruritus may develop, but it is generally not considered an allergic reaction. Antihistamines are the preferred management option should pharmacotherapy treatment be required.
阿片类镇痛药是治疗各种病因所致疼痛的有效药物；然而，不良反应是其使用的潜在限制因素。将阿片类药物不良反应降至最低的策略包括减少剂量、对症处理、阿片类药物轮换以及改变给药途径。约25%的患者会出现恶心；可能无需采取预防措施。确实出现恶心的患者需要使用抗精神病药、促动力药或5-羟色胺拮抗剂进行止吐治疗。了解阿片类药物所致恶心的机制将有助于选择合适的药物。便秘被认为是长期使用阿片类药物的预期副作用。医生应采取预防措施尽量减少便秘的发生。单用软化大便的药物通常无效；软化大便的药物与刺激性泻药联合使用更佳。治疗开始时或剂量增加时会出现镇静和认知改变。基础疾病状态或其他中枢作用药物常常会加重阿片类药物的不良反应。尽量减少不必要的药物使用，并谨慎使用兴奋剂和抗精神病药来处理中枢神经系统副作用。可能会出现瘙痒，但一般不认为是过敏反应。如需药物治疗，抗组胺药是首选的处理方法。
