Vargas-Bermúdez Alejandro, Cardenal Felipe, Porta-Sales Josep
J Pain Palliat Care Pharmacother. 2015;29(4):341-52. doi: 10.3109/15360288.2015.1082005. Epub 2015 Nov 2.
The objective of this study was to review the evidence on the use of opioids for treatment of the dyspnea in adult cancer patients. A systematic literature review was conducted in the databases MEDLINE, CINAHL (EBSCO), ScienceDirect, and Cochrane Library of trials testing the effect of opioids in relieving dyspnea in cancer patients. Fourteen trials met the criteria for inclusion in the review. Eight randomized trials and six nonrandomized trials. All randomized clinical trials analyzed present risks of bias. Morphine has been the most studied strong opioid showing efficacy in alleviating dyspnea when administered, either orally or subcutaneously, in cancer patients. The potential benefit of the strong opioids in the alleviation of dyspnea in cancer patients is modest and limited to some opioids. More studies are needed to sufficiently support the role of opioids in dyspnea at rest, at exertion, and for breakthrough dyspnea and to clarify the safety issues.
本研究的目的是回顾关于使用阿片类药物治疗成年癌症患者呼吸困难的证据。我们在MEDLINE、CINAHL（EBSCO）、ScienceDirect和考科蓝图书馆等数据库中进行了一项系统的文献综述，检索测试阿片类药物缓解癌症患者呼吸困难效果的试验。14项试验符合纳入该综述的标准。其中8项随机试验和6项非随机试验。所有纳入分析的随机临床试验均存在偏倚风险。吗啡是研究最多的强效阿片类药物，在癌症患者口服或皮下给药时，显示出缓解呼吸困难的疗效。强效阿片类药物在缓解癌症患者呼吸困难方面的潜在益处不大，且仅限于某些阿片类药物。需要更多研究来充分支持阿片类药物在静息、运动时呼吸困难以及突发呼吸困难中的作用，并阐明安全性问题。
