Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2017 Sep;54(3):280-288. doi: 10.1016/j.jpainsymman.2017.07.001. Epub 2017 Jul 13.
The lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily dose (MEDD) may lead to poorly controlled pain or overdosing in cancer inpatients.
We aimed to determine the CR and ORR from IV hydromorphone to oral hydromorphone and MEDD (obtained from oral morphine and oxycodone).
A total of 4745 consecutive inpatient palliative care consults during 2010-14 were reviewed for conversions from IV hydromorphone to oral hydromorphone, morphine or oxycodone. Patient characteristics, symptoms, and opioid doses were determined in patients successfully discharged on oral opioids without readmission within one week. Linear regression analysis was used to estimate the CR or ORR between the 24 hour IV hydromorphone mg dose before conversion and the oral opioid mg dose used before discharge.
Among 394 patients on IV hydromorphone, 147 underwent conversion to oral hydromorphone and 247 underwent rotation to oral morphine (163) or oxycodone (84). The median (interquartile range) CR from IV to PO hydromorphone was 2.5 (2.14-2.75) with correlation of 0.95 (P < 0.0001). The median ORR (interquartile range) from IV hydromorphone to MEDD was 11.46 (9.84-13.00) with correlation of 0.93(P < 0.0001). The median ORR was 11.54 in patients receiving <30 mg of IV hydromorphone/day and 9.86 in patients receiving ≥30 mg (P = 0.0004).
Our study found that 1 mg of IV hydromorphone is equivalent to 2.5 mg of oral hydromorphone and 11.46 mg of MEDD. Hydromorphone at doses ≥30 mg/day may require a lower ORR to other opioids.
由于缺乏静脉（IV）给予氢吗啡酮与口服氢吗啡酮之间的精确换算比（CR）以及 IV 给予氢吗啡酮与口服吗啡当量日剂量（MEDD）之间的转换率（ORR）的知识，癌症住院患者可能会出现疼痛控制不佳或用药过量的情况。
我们旨在确定从 IV 给予氢吗啡酮到口服氢吗啡酮以及 MEDD（从口服吗啡和羟考酮获得）的 CR 和 ORR。
回顾了 2010 年至 2014 年期间共 4745 例连续的姑息治疗住院患者的病历，以了解从 IV 给予氢吗啡酮转换为口服氢吗啡酮、吗啡或羟考酮的情况。在没有在一周内再次入院的情况下，成功口服阿片类药物出院的患者，我们确定了患者的特征、症状和阿片类药物剂量。线性回归分析用于估计转换前 24 小时 IV 氢吗啡酮 mg 剂量与出院前口服阿片类药物 mg 剂量之间的 CR 或 ORR。
在 394 例接受 IV 氢吗啡酮治疗的患者中，有 147 例患者进行了口服氢吗啡酮的转换，247 例患者进行了口服吗啡（163 例）或羟考酮（84 例）的转换。从 IV 到 PO 氢吗啡酮的中位数（四分位距）CR 为 2.5（2.14-2.75），相关性为 0.95（P<0.0001）。从 IV 氢吗啡酮到 MEDD 的中位数 ORR（四分位距）为 11.46（9.84-13.00），相关性为 0.93（P<0.0001）。接受 <30mg/d IV 氢吗啡酮治疗的患者的中位数 ORR 为 11.54，接受 ≥30mg/d 氢吗啡酮治疗的患者的中位数 ORR 为 9.86（P=0.0004）。
我们的研究发现，1mg IV 氢吗啡酮相当于 2.5mg 口服氢吗啡酮和 11.46mg MEDD。剂量≥30mg/d 的氢吗啡酮可能需要较低的 ORR 来转换为其他阿片类药物。
