Mercadante Sebastiano, Villari Patrizia, Ferrera Patrizia, David Fabrizio, Intravaia Giuseppe
Anesthesia and Intensive Care Unit, La Maddalena Cancer Center, Palermo, Italy.
J Pain Symptom Manage. 2009 Mar;37(3):419-23. doi: 10.1016/j.jpainsymman.2008.03.019. Epub 2008 Sep 14.
Peripheral edema is a common feature in populations with advanced cancer, although it is seldom recognized. Diuretics are commonly employed and may show some benefit, but there are insufficient clinical trial data to draw useful conclusions about their clinical use. The aim of this prospective study was to evaluate the efficacy and tolerability of high-dose furosemide and small-volume hypertonic saline solution infusion in reducing leg edema in patients with advanced cancer treated unsuccessfully with diuretics. A prospective study was performed in a consecutive sample of 24 patients admitted to a pain relief and palliative care unit over a period of 18 months. To be eligible to enter the trial, advanced cancer patients had to have diffuse bilateral leg edema unresponsive to common doses of diuretics. A solution of 60 mEq of NaCl, 250 mg of furosemide, and 150 mL of normal saline were infused over 20 minutes. The treatment was repeated twice a day for two days and eventually continued on the basis of the clinical outcome. Circumferences were measured at the foot, ankle, calf, and thigh before starting the treatment (T(0)) and at intervals of 24 hours (T(1) and so on). At the same intervals, diuresis was determined. Patients were asked to score their sensation of leg weakness/heaviness on a numerical scale from 0 to 10, before (T(0)) and after the treatment (T(end)). An appreciable improvement in the sensation of weakness/heaviness (score reduction of at least two points) was recorded in all the patients. A small decrease in leg circumferences at the different sites was found, and a mean of 3600 mL/day of diuresis was recorded. These observations suggest that high-dose furosemide and small-volume saline may be an effective strategy for the treatment of peripheral edema in patients with advanced cancer.
外周水肿是晚期癌症患者群体中的常见特征，尽管它很少被认识到。利尿剂通常被使用，可能会显示出一些益处，但缺乏足够的临床试验数据来得出关于其临床应用的有用结论。这项前瞻性研究的目的是评估大剂量呋塞米和小容量高渗盐溶液输注对利尿剂治疗无效的晚期癌症患者减轻腿部水肿的疗效和耐受性。在18个月期间，对连续收治到疼痛缓解和姑息治疗病房的24例患者进行了一项前瞻性研究。要符合进入试验的条件，晚期癌症患者必须有弥漫性双侧腿部水肿，对常用剂量的利尿剂无反应。将60毫当量氯化钠、250毫克呋塞米和150毫升生理盐水的溶液在20分钟内输注完毕。该治疗每天重复两次，持续两天，并最终根据临床结果继续进行。在开始治疗前（T(0)）以及每隔24小时（T(1)等）测量足部、脚踝、小腿和大腿的周长。在相同的时间间隔内，测定尿量。要求患者在治疗前（T(0)）和治疗后（T(end)）用0至10的数字评分来评估他们腿部无力/沉重的感觉。所有患者均记录到无力/沉重感有明显改善（评分至少降低2分）。发现不同部位的腿部周长略有减小，平均尿量记录为每天3600毫升。这些观察结果表明，大剂量呋塞米和小容量盐水可能是治疗晚期癌症患者外周水肿的有效策略。
