1 South College School of Pharmacy , Knoxville, Tennessee.
J Palliat Med. 2013 Oct;16(10):1205-9. doi: 10.1089/jpm.2012.0467. Epub 2013 Aug 9.
To date, there are no known published studies that prospectively followed hospice patients receiving hydromorphone to evaluate the development of hydromorphone-induced neuroexcitation (HINE). The first objective of this study was to determine the incidence of HINE. The second objective was to identify factors influencing the presence or absence of HINE symptoms in hospice patients.
This was a noninterventional, prospective study. This study population included hospice patients 18 years of age or older who were admitted to one of two Nathan Adelson Hospice inpatient units in Las Vegas, Nevada, and were initiated on a scheduled regimen of hydromorphone. A total of 156 patients were enrolled and analyzed in this study. Data collection was performed by the study investigators using a standard data tracking form, including hospice diagnosis, gender, renal function, hydromorphone regimen, and whether or not the patient experienced neuroexcitatory symptoms. Data collection occurred from November 2010 to March 2011.
Based on the data collected in this study, it appears that the likelihood of HINE does increase with larger doses, increasing age, increasing serum creatinine, and the presence of malignant neoplasm. However, after adjusting for the variables in the logistic regression model, diagnosis of malignant neoplasm was not a significant predictor of HINE. Future studies may focus on evaluating metabolite levels, such as hydromorphone-3-glucuronide (H3G), in patients developing HINE symptoms. This may help to determine if the metabolites of opioids, such as H3G, are involved in the development of the neurotoxic symptoms.
迄今为止，尚无已知的前瞻性研究随访接受氢吗啡酮的临终关怀患者，以评估氢吗啡酮诱导的神经兴奋（HINE）的发展。本研究的首要目的是确定 HINE 的发生率。第二个目的是确定影响 hospice 患者是否存在 HINE 症状的因素。
这是一项非干预性、前瞻性研究。本研究人群包括年龄在 18 岁或以上的 hospice 患者，他们被收治到内华达州拉斯维加斯的 Nathan Adelson Hospice 两个住院病房之一，并开始接受氢吗啡酮的计划治疗方案。共有 156 名患者入组并在本研究中进行了分析。研究人员使用标准数据跟踪表收集数据，包括 hospice 诊断、性别、肾功能、氢吗啡酮治疗方案以及患者是否出现神经兴奋症状。数据收集于 2010 年 11 月至 2011 年 3 月进行。
根据本研究收集的数据，HINE 的可能性似乎确实随着较大剂量、年龄增长、血清肌酐升高和恶性肿瘤的存在而增加。然而，在校正逻辑回归模型中的变量后，恶性肿瘤的诊断并不是 HINE 的显著预测因素。未来的研究可能集中于评估代谢物水平，如氢吗啡酮-3-葡萄糖醛酸（H3G），在出现 HINE 症状的患者中。这可能有助于确定是否阿片类药物的代谢物，如 H3G，参与了神经毒性症状的发展。
