Clemens Katri Elina, Klaschik Eberhard
Department of Science and Research in Palliative Medicine, University of Bonn, and Center for Palliative Medicine, Malteser Hospital Bonn/Rhein-Sieg Bonn, Germany.
J Pain Symptom Manage. 2007 Apr;33(4):473-81. doi: 10.1016/j.jpainsymman.2006.09.015.
This study assessed the effect of opioid treatment on ventilation in dyspneic palliative care patients who received symptomatic treatment with strong opioids. The assessments measured changes in peripheral arterial oxygen saturation (SaO(2)), transcutaneous arterial pressure of carbon dioxide (tcPCO(2)), respiratory rate (f), and pulse rate (PF) during the titration phase with morphine or hydromorphone. The aims of the study were to verify the efficacy of opioids for the management of dyspnea, assess the effect on ventilation, and show whether nasal O(2) insufflation before opioid application leads to a decrease in the intensity of dyspnea. Eleven patients admitted to our palliative care unit were included in this prospective, nonrandomized trial. At admission, all patients suffered from dyspnea. tcPCO(2), SaO(2), and PF were measured transcutaneously by means of a SenTec Digital Monitor (SenTec AG, Switzerland). During O(2) insufflation, the intensity of dyspnea did not change. In contrast, the opioid produced a significant improvement in the intensity of dyspnea (P=0.003). Mean f decreased as early as 30 minutes after the first opioid administration, declining from 41.8+/-4.7 (35.0-50.0) to 35.5+/-4.2 (30.0-40.0), and after 90 minutes, to 25.7+/-4.5 (20.0-32.0) breaths/min. Other monitored respiratory parameters, however, showed no significant changes. There was no opioid-induced respiratory depression.
本研究评估了阿片类药物治疗对接受强效阿片类药物对症治疗的呼吸困难姑息治疗患者通气功能的影响。评估指标包括在使用吗啡或氢吗啡酮滴定阶段外周动脉血氧饱和度（SaO₂）、经皮二氧化碳分压（tcPCO₂）、呼吸频率（f）和脉搏率（PF）的变化。本研究的目的是验证阿片类药物治疗呼吸困难的疗效，评估其对通气功能的影响，并观察在应用阿片类药物前进行鼻内给氧是否会导致呼吸困难强度降低。本前瞻性、非随机试验纳入了11名入住我们姑息治疗病房的患者。入院时，所有患者均有呼吸困难症状。通过SenTec数字监测仪（瑞士SenTec AG公司）经皮测量tcPCO₂、SaO₂和PF。在给氧过程中，呼吸困难强度未发生变化。相比之下，阿片类药物使呼吸困难强度有显著改善（P = 0.003）。首次给予阿片类药物后30分钟，平均呼吸频率f即开始下降，从41.8±4.7（35.0 - 50.0）次/分钟降至35.5±4.2（30.0 - 40.0）次/分钟，90分钟后降至25.7±4.5（20.0 - 32.0）次/分钟。然而，其他监测的呼吸参数未显示出显著变化。未出现阿片类药物引起的呼吸抑制。
