Gamborg Helle, Riis Jette, Christrup Lona, Krantz Torben
Sankt Lukas Hospice, Bernstorffsvej 20, DK-2900 Hellerup, Denmark.
Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen Ø.
J Opioid Manag. 2013 Jul-Aug;9(4):269-74. doi: 10.5055/jom.2013.0168.
Dyspnea is considered as one of the most frequent and distressing symptoms in patients with advanced cancer, and systemic administration of morphine has been reported to have beneficial effect on this complaint.
The effect of red morphine drops (RMD) given orally and kept in the mouth as long as possible before swallowing to alleviate dyspnea was compared to the effect of morphine given subcutaneously (SCM) in a double-blind, double-dummy trial.
Twenty consecutive terminally ill patients with primary lung cancer or lung metastases admitted to Sankt Lukas Hospice were included in the study. All patients had dyspnea at rest, and they received either 1/12 of their 24-hour morphine dose as RMD or 60 percent of this dose as SCM. Perceived breathlessness was evaluated on a Visual Analogue Scale (VAS) during a 60 minutes observation time, and pulse rate, respiratory rate and oxygen saturation were assessed as well.
Compared to baseline both RMD and SCM showed a small, but statistical significant effect on VAS (mean decrease of 1.1 [RMD] and 1.7 [SCM]) and pulse rate (mean decrease of 4 per minute [RMD] and 6 per minute [SCM]), the effect being significantly larger after SCM.
The study confirms the beneficial effect of morphine on dyspnea in terminally ill patients, and we conclude that RMD is an attractive alternative to injected morphine, when self-administration is preferable.
呼吸困难被认为是晚期癌症患者最常见且痛苦的症状之一，据报道吗啡全身给药对该症状有有益作用。
在一项双盲、双模拟试验中，比较了口服红色吗啡滴剂（RMD）并在吞咽前尽可能长时间含于口中以缓解呼吸困难的效果与皮下注射吗啡（SCM）的效果。
连续纳入了20名入住圣卢卡斯临终关怀院的晚期原发性肺癌或肺转移患者。所有患者静息时均有呼吸困难，他们接受24小时吗啡剂量的1/12作为RMD或该剂量的60%作为SCM。在60分钟观察期内通过视觉模拟量表（VAS）评估主观呼吸困难程度，并评估脉搏率、呼吸频率和血氧饱和度。
与基线相比，RMD和SCM对VAS（平均下降1.1[RMD]和1.7[SCM]）和脉搏率（平均每分钟下降4次[RMD]和6次[SCM]）均显示出较小但具有统计学意义的效果，SCM后的效果明显更大。
该研究证实了吗啡对晚期患者呼吸困难的有益作用，我们得出结论，当更倾向于自我给药时，RMD是注射用吗啡的一种有吸引力的替代方法。
