Dickman Andrew, Bickerstaff Matthew, Jackson Richard, Schneider Jennifer, Mason Stephen, Ellershaw John
Marie Curie Palliative Care Institute Liverpool, Cancer Research Centre, Liverpool, L3 9TA, UK.
Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, L69 3GL, UK.
BMC Palliat Care. 2017 Mar 23;16(1):22. doi: 10.1186/s12904-017-0195-y.
A continuous subcutaneous infusion (CSCI) delivered via syringe pump is a method of drug administration used to maintain symptom control when a patient is no longer able to tolerate oral medication. Several classes of drugs, such as opioids, antiemetics, anticholinergics, antipsychotics and benzodiazepines are routinely administered by CSCI alone or in combinations. Previous studies attempting to identify the most-common CSCI combinations are now several years old and no longer reflect current clinical practice. The aim of this work was to review current clinical practice and identify CSCI drug combinations requiring analysis for chemical compatibility and stability.
UK pharmacy professionals involved in the delivery of care to palliative patients in hospitals and hospices were invited to enter CSCI combinations comprised of two or more drugs onto an electronic database over a 12-month period. In addition, a separate Delphi study with a panel of 15 expert healthcare professionals was completed to identify a maximum of five combinations of drugs used to treat more complex, but less commonly encountered symptoms unlikely to be identified by the national survey.
A total of 57 individuals representing 33 separate palliative care services entered 1,945 drug combinations suitable for analysis, with 278 discrete combinations identified. The top 40 drug combinations represented nearly two-thirds of combinations recorded. A total of 23 different drugs were administered in combination and the median number of drugs in a combination was three. The Delphi study identified five combinations for the relief of complex or refractory symptoms.
This study represents the first step towards developing authoritative national guidance on the administration of drugs by CSCI. Further work will ensure healthcare practitioners have the knowledge and confidence that a prescribed combination will be both safe and efficacious.
通过注射泵进行的连续皮下输注（CSCI）是一种给药方法，用于在患者无法耐受口服药物时维持症状控制。几类药物，如阿片类药物、止吐药、抗胆碱能药、抗精神病药和苯二氮䓬类药物，常单独或联合通过CSCI给药。以往试图确定最常见的CSCI联合用药的研究距今已有数年，不再反映当前的临床实践。这项工作的目的是回顾当前的临床实践，并确定需要分析化学相容性和稳定性的CSCI药物组合。
邀请参与为医院和临终关怀机构的姑息治疗患者提供护理的英国药剂师在12个月内将由两种或更多药物组成的CSCI联合用药输入电子数据库。此外，还完成了一项针对15名医疗保健专家组成的小组的德尔菲研究，以确定最多五种用于治疗更复杂但较少见症状的药物组合，而这些症状不太可能通过全国性调查确定。
代表33个独立姑息治疗服务机构的57人输入了1945种适合分析的药物组合，共识别出278种不同的组合。前40种药物组合占记录组合的近三分之二。总共23种不同的药物联合使用，组合中药物的中位数为三种。德尔菲研究确定了五种用于缓解复杂或难治性症状的组合。
本研究是朝着制定关于CSCI给药的权威性国家指南迈出的第一步。进一步的工作将确保医疗从业者了解并相信规定的联合用药既安全又有效。
