Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, Maoming, China.
Southern Medical University, Guangzhou, China.
J Pain Symptom Manage. 2021 Jan;61(1):198-210.e1. doi: 10.1016/j.jpainsymman.2020.07.021. Epub 2020 Jul 27.
Dyspnea is one of the most distressing symptoms encountered by advanced cancer patients. In this study, we aimed to evaluate the role of opioids in the management of cancer-related dyspnea.
A systematic review and meta-analysis based on Randomized Controlled Trials was conducted in the databases PUBMED, EMBASE, and Cochrane Central Register of Controlled Trials testing the effect of opioids in relieving cancer-related dyspnea. Subgroup and sensitivity analyses were performed to evaluate various types of opioids in dyspnea management and stabilization of the study respectively.
Eleven RCTs fulfilled the eligibility criteria and had a total of 290 participants. Nine of these studies were included in meta-analyses. Compared with control, opioid therapy showed a small positive effect in dyspnea, SMD-0.82 (95%CI = -1.54 to -0.10) and Borg score, WMD-0.95 (95%CI = -1.83 to -0.06); Opioid therapy did not increase the risk of somnolence, OR0.93 (95%CI = 0.34 to 2.58), whereas a negative effect on respiratory rate was observed,WMD-1.89 (95%CI = -3.36 to -0.43); Also, there was no evidence to suggest improved performance of the 6MWT test, WMD6.49 (95%CI = -34.23 to 47.21), or the level of peripheral oxygen saturation, WMD0.33 (95%CI = -0.59 to 1.24) after opioid therapy. Subgroup analysis yielded a small positive effect for morphine on dyspnea, SMD-0.78 (95%CI = -1.45 to -0.10), whereas fentanyl showed no improvement in dyspnea, SMD-0.44 (95%CI = -0.89 to 0.02). Sensitivity analysis showed no changes in the direction of effect when any one study was excluded from the meta-analyses.
Our systematic review and meta-analysis indicated low quality evidence for a small positive effect of opioids in cancer-related dyspnea. Evidence for safety is insufficient as comprehensive adverse events were not adequately reported in studies.
呼吸困难是晚期癌症患者最痛苦的症状之一。在这项研究中，我们旨在评估阿片类药物在癌症相关呼吸困难管理中的作用。
我们在 PUBMED、EMBASE 和 Cochrane 对照试验中心注册数据库中进行了一项基于随机对照试验的系统评价和荟萃分析，以评估阿片类药物在缓解癌症相关呼吸困难方面的效果。进行了亚组和敏感性分析，以评估在呼吸困难管理和研究稳定性中各种类型的阿片类药物。
11 项 RCT 符合入选标准，共有 290 名参与者。其中 9 项研究纳入荟萃分析。与对照组相比，阿片类药物治疗在呼吸困难方面显示出较小的积极作用，SMD-0.82（95%CI=-1.54 至-0.10）和 Borg 评分，WMD-0.95（95%CI=-1.83 至-0.06）；阿片类药物治疗并没有增加嗜睡的风险，OR0.93（95%CI=0.34 至 2.58），而呼吸频率观察到负面影响，WMD-1.89（95%CI=-3.36 至-0.43）；此外，没有证据表明阿片类药物治疗后 6 分钟步行试验（6MWT）的表现有所改善，WMD6.49（95%CI=-34.23 至 47.21），或外周血氧饱和度水平，WMD0.33（95%CI=-0.59 至 1.24）。亚组分析显示吗啡对呼吸困难有较小的积极作用，SMD-0.78（95%CI=-1.45 至-0.10），而芬太尼对呼吸困难没有改善，SMD-0.44（95%CI=-0.89 至 0.02）。敏感性分析表明，当任何一项研究从荟萃分析中排除时，效果方向没有变化。
我们的系统评价和荟萃分析表明，阿片类药物治疗癌症相关呼吸困难的疗效证据质量较低，仅有小的积极作用。由于研究没有充分报告全面的不良事件，因此安全性证据不足。
