Heiskanen Tarja, Langel Kaarina, Gunnar Teemu, Lillsunde Pirjo, Kalso Eija A
Pain Clinic, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Alcohol and Drug Analytics Unit, National Institute for Health and Welfare, Helsinki, Finland.
J Pain Symptom Manage. 2015 Oct;50(4):524-32. doi: 10.1016/j.jpainsymman.2014.09.004. Epub 2014 Sep 19.
Measuring opioid concentrations in pain treatment is warranted in situations where optimal opioid analgesia is difficult to reach.
To assess the usefulness of oral fluid (OFL) as an alternative to plasma in opioid concentration monitoring in cancer patients on chronic opioid therapy.
We collected OFL and plasma samples from 64 cancer patients on controlled-release (CR) oral morphine, CR oral oxycodone, or transdermal (TD) fentanyl for pain. Samples were obtained on up to five separate days.
A total of 213 OFL and plasma samples were evaluable. All patients had detectable amounts of the CR or TD opioid in both plasma and OFL samples. The plasma concentrations of oxycodone and fentanyl (determination coefficient R(2) = 0.628 and 0.700, respectively), but not morphine (R(2) = 0.292), were moderately well correlated to the daily opioid doses. In contrast to morphine and fentanyl (mean OFL/plasma ratio 2.0 and 3.0, respectively), the OFL oxycodone concentrations were significantly higher than the respective plasma concentrations (mean OFL/plasma ratio 14.9). An active transporter could explain the much higher OFL vs. plasma concentrations of oxycodone compared with morphine and fentanyl.
OFL analysis is well suited for detecting the studied opioids. For morphine and fentanyl, an approximation of the plasma opioid concentrations is obtainable, whereas for oxycodone, the OFL/plasma concentration relationship is too variable for reliable approximation results.
在难以实现最佳阿片类药物镇痛效果的情况下，对疼痛治疗中的阿片类药物浓度进行测量是有必要的。
评估口腔液（OFL）作为慢性阿片类药物治疗的癌症患者阿片类药物浓度监测中替代血浆的有用性。
我们收集了64例接受控释（CR）口服吗啡、CR口服羟考酮或透皮（TD）芬太尼治疗疼痛的癌症患者的OFL和血浆样本。样本在多达五个不同的日子采集。
总共213份OFL和血浆样本可用于评估。所有患者的血浆和OFL样本中均检测到可测量的CR或TD阿片类药物。羟考酮和芬太尼的血浆浓度（决定系数R²分别为0.628和0.700）与每日阿片类药物剂量呈中度良好相关，但吗啡（R² = 0.292）并非如此。与吗啡和芬太尼（平均OFL/血浆比值分别为2.0和3.0）不同，OFL中的羟考酮浓度显著高于各自的血浆浓度（平均OFL/血浆比值为14.9）。一种主动转运体可以解释羟考酮的OFL浓度与血浆浓度相比远高于吗啡和芬太尼的原因。
OFL分析非常适合检测所研究的阿片类药物。对于吗啡和芬太尼，可以获得血浆阿片类药物浓度的近似值，而对于羟考酮，OFL/血浆浓度关系变化太大，无法获得可靠的近似结果。
