Berger Jeffrey, Lester Paula, Rodrigues Lucan
Divisions of Palliative Medicine and Geriatrics, Winthrop University Hospital, Mineola, NY, USA.
Divisions of Geriatrics and Palliative Medicine, Winthrop University Hospital, Mineola, NY, USA.
Am J Hosp Palliat Care. 2016 May;33(4):407-10. doi: 10.1177/1049909115569047. Epub 2015 Feb 2.
Malignant bowel obstruction is a highly symptomatic, often recurrent, and sometimes refractory condition in patients with intra-abdominal tumor burden. Gastro-intestinal symptoms and function may improve with anti-inflammatory, anti-secretory, and prokinetic/anti-nausea combination medical therapy.
To describe the effect of octreotide, metoclopramide, and dexamethasone in combination on symptom burden and bowel function in patients with malignant bowel obstruction and dysfunction.
A retrospective case series of patients with malignant bowel obstruction (MBO) and malignant bowel dysfunction (MBD) treated by a palliative care consultation service with octreotide, metoclopramide, and dexamethasone. Outcomes measures were nausea, pain, and time to resumption of oral intake.
12 cases with MBO, 11 had moderate/severe nausea on presentation. 100% of these had improvement in nausea by treatment day #1. 100% of patients with moderate/severe pain improved to tolerable level by treatment day #1. The median time to resumption of oral intake was 2 days (range 1-6 days) in the 8 cases with evaluable data. Of 7 cases with MBD, 6 had For patients with malignant bowel dysfunction, of those with moderate/severe nausea. 5 of 6 had subjective improvement by day#1. Moderate/severe pain improved to tolerable levels in 5/6 by day #1. Of the 4 cases with evaluable data on resumption of PO intake, time to resume PO ranged from 1-4 days.
Combination medical therapy may provide rapid improvement in symptoms associated with malignant bowel obstruction and dysfunction.
恶性肠梗阻是一种症状严重、常复发且有时难以治疗的疾病，见于有腹腔内肿瘤负荷的患者。胃肠道症状和功能可能通过抗炎、抗分泌及促动力/抗恶心联合药物治疗得到改善。
描述奥曲肽、甲氧氯普胺和地塞米松联合使用对恶性肠梗阻和功能障碍患者症状负担及肠功能的影响。
一项回顾性病例系列研究，纳入接受姑息治疗咨询服务，使用奥曲肽、甲氧氯普胺和地塞米松治疗的恶性肠梗阻（MBO）和恶性肠功能障碍（MBD）患者。观察指标为恶心、疼痛及恢复经口进食的时间。
12例MBO患者中，11例初诊时有中度/重度恶心。其中100%在治疗第1天时恶心症状改善。100%中度/重度疼痛患者在治疗第1天时疼痛改善至可耐受水平。8例有可评估数据的患者恢复经口进食的中位时间为2天（范围1 - 6天）。7例MBD患者中，6例有……对于恶性肠功能障碍患者，那些有中度/重度恶心的患者。6例中有5例在第1天时主观症状改善。6例中有5例在第1天时中度/重度疼痛改善至可耐受水平。4例有恢复经口进食可评估数据的患者，恢复经口进食的时间为1 - 4天。
联合药物治疗可能使与恶性肠梗阻和功能障碍相关的症状迅速改善。
