Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway.
Palliat Med. 2011 Jul;25(5):494-503. doi: 10.1177/0269216310384902.
According to a Cochrane review on opioid switching, sound evidence on the practice of substituting one strong opioid with another to improve pain control and reduce adverse effects was lacking in 2004. A systematic search strategy was developed to include studies after 2004, with adult cancer patients switching between strong opioids and reporting estimates of effect on pain and adverse effects. The search retrieved 288 publications (71 duplicates); 187 abstracts and 19 full papers were excluded. Eleven papers met the inclusion criteria; none were randomized controlled trials/meta-analyses. Studies comprised 280 patients (group size 10-32). A variety of opioids and switching strategies were studied. Pain intensity was significantly reduced in the majority of studies. Serious adverse effects were improved. Due to serious design limitations, the level of evidence was low (D). Randomized trials, with standardization of cohort classification, use of outcomes and analysis are warranted to establish the practice of opioid switching.
根据 Cochrane 对阿片类药物转换的综述，2004 年时，对于用一种强阿片类药物替代另一种以改善疼痛控制和减少不良反应的做法，缺乏有力证据。制定了一个系统的检索策略，以纳入 2004 年后的研究，这些研究的对象是在强阿片类药物之间转换并报告对疼痛和不良反应影响的估计的成年癌症患者。检索到 288 篇出版物（71 篇重复）；187 篇摘要和 19 篇全文被排除在外。符合纳入标准的有 11 篇论文；均非随机对照试验/荟萃分析。研究包括 280 名患者（每组 10-32 人）。研究了各种阿片类药物和转换策略。大多数研究都显著降低了疼痛强度。严重不良反应得到改善。由于严重的设计局限性，证据水平较低（D）。需要进行随机试验，标准化队列分类、使用结局和分析，以确定阿片类药物转换的做法。
