Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
J Pain Symptom Manage. 2011 Feb;41(2):421-5. doi: 10.1016/j.jpainsymman.2010.04.022. Epub 2010 Sep 15.
Constipation is a common problem for advanced cancer patients, and is generally inadequately treated.
The aim of this study was to prospectively evaluate the effectiveness and tolerability of amidotrizoate (AM) in patients unresponsive to current laxatives.
A consecutive sample of advanced cancer patients was surveyed. Inclusion criteria were no bowel movements for three days despite receiving regular doses of senna or lactulose. AM 50 mL was administered orally; the dose could be repeated the day after, based on clinical judgment and/or patients' preference. Age, sex, primary tumor, previous abdominal surgery, chemotherapy and radiotherapy performed in the previous month, and the use of opioids were recorded. Nausea, the presence of early satiety, and fluid and food intake also were measured. Time to first bowel movement was recorded, and adverse effects attributable to AM.
Ninety-nine patients were surveyed (36 women/63 men). The mean age was 65.7 years (SD±12.2) and the mean Karnofsky score was 46.8 (SD±9.4). Patients had no bowel movement for a mean of four days (SD±1.8, range 3-15 days). A total of 80.8% of patients were receiving opioids in doses of mean daily oral morphine equivalents of 164 mg (SD±235). After AM administration (mean 9.9±6.5 hours), 44.4% of patients had a bowel movement within 24 hours. This effect was associated with significant improvement of other symptoms and was independent of age (P=0.513), gender (P=0.090), Karnofsky status (P=0.979), days of constipation (P=0.198), concomitant chemotherapy (P=0.098) or radiotherapy (P=0.414), the use of opioids (P=0.361), opioid doses (P=0.420), and primary tumor (P=0.231). The treatment was more effective in patients who had previous abdominal surgery (HR=3.33).
AM was found to be an easy and inexpensive breakthrough medication to induce a bowel movement in about 45% of advanced cancer patients not responsive to common laxatives, with limited and acceptable adverse effects.
便秘是晚期癌症患者的常见问题，通常治疗不足。
本研究旨在前瞻性评估氨芐蝶啶（AM）在对现有泻药无反应的患者中的疗效和耐受性。
对连续样本的晚期癌症患者进行调查。纳入标准为尽管接受了常规剂量的番泻叶或乳果糖，但连续三天没有排便。口服 AM 50 毫升；根据临床判断和/或患者的偏好，可在第二天重复剂量。记录年龄、性别、原发肿瘤、既往腹部手术、前一个月接受的化疗和放疗以及阿片类药物的使用情况。还测量了恶心、早饱感以及液体和食物的摄入。记录首次排便的时间，并记录与 AM 相关的不良反应。
共调查了 99 例患者（36 例女性/63 例男性）。平均年龄为 65.7 岁（标准差±12.2），平均卡诺夫斯基评分 46.8（标准差±9.4）。患者平均无排便 4 天（标准差±1.8，范围 3-15 天）。80.8%的患者接受阿片类药物治疗，平均每日口服吗啡等效剂量为 164 毫克（标准差±235）。给予 AM 后（平均 9.9±6.5 小时），44.4%的患者在 24 小时内排便。这种效果与其他症状的显著改善相关，与年龄（P=0.513）、性别（P=0.090）、卡诺夫斯基状态（P=0.979）、便秘天数（P=0.198）、同期化疗（P=0.098）或放疗（P=0.414）、阿片类药物的使用（P=0.361）、阿片类药物剂量（P=0.420）和原发肿瘤（P=0.231）无关。对于有既往腹部手术史的患者（HR=3.33），AM 是一种更有效的治疗方法。
AM 被发现是一种简单且廉价的突破性药物，可使约 45%对常用泻药无反应的晚期癌症患者产生排便，不良反应有限且可接受。
