Mercadante Sebastiano, Ferrera Patrizia, Casuccio Alessandra
Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
Am J Hosp Palliat Care. 2010 Dec;27(8):514-7. doi: 10.1177/1049909110366010. Epub 2010 May 3.
The aim of this survey was to assess the opioid use in the last week of life of cancer patients admitted at an acute palliative care unit. From a consecutive sample of patients surveyed for a period of one year, patients who died in the unit were selected. Type of opioid, route of administration, and doses were recorded one week before death (or at admission time if the interval admission-death was less than one week) (-7), and on the day of death (Tend). Seventy-seven patients died in the unit in the period taken into consideration (12.4%). Oral morphine equivalents were 170 mg/day and 262 mg/day at -7 and Tend, respectively. Patients were receiving transdermal drugs or intravenous morphine at Tend, with a trend in the use of intravenous morphine at Tend (p=0.07). Intravenous morphine was more frequently used in sedated patients at Tend (p=0.015).No differences in age, gender, opioid doses, and OEI were found among opioids used. In patients who were sedated doses of opioids were significantly increased (p=0.012). In the last week of life intravenous morphine is the preferred modality to deliver opioids in an acute palliative care unit. Doses increases prevalently observed in sedated patients were performed before starting sedation with the purpose to treat concomitant distressing symptoms, such as dyspnoea.
本次调查的目的是评估入住急性姑息治疗病房的癌症患者生命最后一周的阿片类药物使用情况。从连续一年接受调查的患者样本中，选取在该病房死亡的患者。记录死亡前一周（若入院至死亡间隔小于一周，则为入院时）（-7）以及死亡当天（Tend）的阿片类药物类型、给药途径和剂量。在考虑的时间段内，该病房有77名患者死亡（12.4%）。-7时和Tend时口服吗啡当量分别为170毫克/天和262毫克/天。在Tend时，患者接受透皮药物或静脉注射吗啡，且Tend时有使用静脉注射吗啡的趋势（p = 0.07）。在Tend时，静脉注射吗啡在接受镇静的患者中使用更为频繁（p = 0.015）。在所使用的阿片类药物之间，未发现年龄、性别、阿片类药物剂量和OEI存在差异。在接受镇静的患者中，阿片类药物剂量显著增加（p = 0.012）。在生命的最后一周，静脉注射吗啡是急性姑息治疗病房给药阿片类药物的首选方式。在接受镇静的患者中普遍观察到的剂量增加是在开始镇静之前进行的，目的是治疗诸如呼吸困难等伴随的痛苦症状。
