Estfan Bassam, Mahmoud Fade, Shaheen Philip, Davis Mellar P, Lasheen Wael, Rivera Nilo, Legrand Susan B, Lagman Ruth L, Walsh Declan, Rybicki Lisa
The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Palliat Med. 2007 Mar;21(2):81-6. doi: 10.1177/0269216307077328.
Respiratory depression is the most feared opioid-related side-effect yet research on the topic is sparse. We evaluated changes in respiratory parameters during parenteral opioid titration for cancer pain to determine if opioid titration was associated with evidence of hypoventilation. The primary outcome measure was to measure changes in end-tidal CO(2) (ET-CO(2)) during opioid titration to pain control.
Subjects with severe cancer pain admitted for parenteral opioid titration for poorly controlled pain were eligible. Those who were oxygen dependent were excluded. ET-CO(2), O(2) saturation, respiratory rate (RR), and vital signs were monitored daily until pain control was achieved.
30 patients completed the study of which 29 are reported. The mean ET-CO(2) at initial evaluation was 33.39 -/+ 5.0 and 34.79 -/+ 5.7 mmHg at pain control (P =0.14, 95% CI -0.5 to 3.3). None had an ET-CO(2) > or =50 mmHg. All maintained O(2) saturation > or = 92%. RR dropped transiently below 10/minute in two subjects.
Parenteral opioid titration for relief of cancer pain was not associated with respiratory depression as demonstrated by significant changes in ET-CO(2) or oxygen saturation in non-oxygen dependent cancer patients.
呼吸抑制是最令人担忧的阿片类药物相关副作用，但关于该主题的研究却很稀少。我们评估了癌症疼痛患者胃肠外阿片类药物滴定期间呼吸参数的变化，以确定阿片类药物滴定是否与通气不足的证据相关。主要结局指标是测量阿片类药物滴定至疼痛得到控制期间呼气末二氧化碳（ET-CO₂）的变化。
入选因疼痛控制不佳而接受胃肠外阿片类药物滴定的重度癌症疼痛患者。排除那些依赖氧气的患者。每天监测ET-CO₂、氧饱和度、呼吸频率（RR）和生命体征，直至疼痛得到控制。
30例患者完成研究，其中29例纳入报告。初始评估时平均ET-CO₂为33.39±5.0 mmHg，疼痛得到控制时为34.79±5.7 mmHg（P = 0.14，95%CI -0.5至3.3）。无人的ET-CO₂≥50 mmHg。所有患者的氧饱和度均维持在≥92%。两名受试者的RR短暂降至10次/分钟以下。
对于非依赖氧气的癌症患者，胃肠外阿片类药物滴定用于缓解癌症疼痛与呼吸抑制无关，这可通过ET-CO₂或氧饱和度的显著变化得到证明。
