Dept of Health Services Research, Maastricht University, Maastricht, The Netherlands
Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Eur Respir J. 2017 Nov 22;50(5). doi: 10.1183/13993003.01153-2017. Print 2017 Nov.
Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. The aim of this study was to systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness.PubMed, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible.We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in carbon dioxide tension (0.27 kPa, 95% CI 0.08-0.45 kPa,) and no significant change in oxygen tension and oxygen saturation (both p>0.05). Nonserious respiratory depression (definition variable/not stated) was described in four out of 1064 patients. One cancer patient pretreated with morphine for pain needed temporary respiratory support following nebulised morphine for breathlessness (single case study).We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed.
先前的研究表明，阿片类药物可减轻晚期疾病患者的慢性呼吸困难。然而，医生仍然不愿意为这些患者开阿片类药物，通常是因为担心呼吸不良反应。本研究旨在系统回顾晚期疾病和慢性呼吸困难患者使用阿片类药物的报告呼吸不良反应。检索了 PubMed、Embase、Cochrane 中央对照试验注册库、CINAHL、ClinicalTrials.gov 和相关系统评价的参考文献列表。两名独立研究人员根据预先设定的纳入标准进行筛选并提取数据。在可能的情况下进行了荟萃分析。我们纳入了 1990 篇文章中的 63 篇，描述了 67 项研究。荟萃分析显示二氧化碳分压升高（0.27 kPa，95%CI 0.08-0.45 kPa），而氧分压和氧饱和度无显著变化（均 p>0.05）。在 1064 例患者中有 4 例出现非严重呼吸抑制（定义变量/未说明）。一名接受吗啡治疗疼痛的癌症患者在接受雾化吗啡治疗呼吸困难后需要临时呼吸支持（单病例研究）。我们没有发现阿片类药物治疗慢性呼吸困难有显著或临床相关的呼吸不良反应的证据。设计和研究人群的异质性以及研究质量低是局限性。需要更大规模的研究来检测呼吸不良反应。
