Gotou Masayuki, Suzuki Atsushi, Shiga Tsuyoshi, Wakabayashi Rumi, Nakazawa Mayui, Kikuchi Noriko, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Drugs Real World Outcomes. 2022 Mar;9(1):1-8. doi: 10.1007/s40801-021-00281-4. Epub 2021 Oct 6.
Opioids have been reported to be effective for refractory dyspnea in patients with advanced heart failure (HF) in the palliative care setting.
The aim of this study was to evaluate the incidence of adverse drug reactions (ADRs) and their relationship with morphine dose/duration or renal insufficiency in patients with end-stage HF receiving continuous morphine infusion.
We retrospectively studied 38 patients with end-stage HF receiving continuous intravenous or subcutaneous morphine infusion for the relief of breathlessness between 2014 and 2019 (mean age 78 years). The endpoints were nausea/vomiting, respiratory depression, and drowsiness, which are common morphine-related ADRs.
Of 38 patients with end-stage HF receiving continuous intravenous/subcutaneous morphine infusion, 14 (37%) experienced ADRs. The median estimated glomerular filtration rate (eGFR) was lower in patients with than in those without ADRs (16 [range 9-48] vs. 41 [range 8-133], respectively; p = 0.011). The ADRs with the highest incidence were drowsiness (n = 13), nausea/vomiting (n =5), and respiratory depression (n =3). There were no differences in the maintenance dose or duration of morphine administration between patients with and without ADRs. A baseline eGFR of 32 mL/min/1.73 m was a good cutoff value for ADR prediction (sensitivity 86%, specificity 96%). A baseline eGFR < 32 mL/min/1.73 m was significantly associated with the occurrence of morphine-related ADRs (odds ratio 6.63, 95% confidence interval 1.19-37.01).
Our results showed that 37% of patients with end-stage HF receiving continuous intravenous/subcutaneous morphine infusion experienced ADRs, especially drowsiness. Patients with eGFR < 32 mL/min/1.73 m were likely to experience morphine-related ADRs.
据报道，在姑息治疗环境中，阿片类药物对晚期心力衰竭（HF）患者的难治性呼吸困难有效。
本研究旨在评估接受持续吗啡输注的终末期HF患者药物不良反应（ADR）的发生率及其与吗啡剂量/持续时间或肾功能不全的关系。
我们回顾性研究了2014年至2019年期间38例接受持续静脉或皮下吗啡输注以缓解呼吸困难的终末期HF患者（平均年龄78岁）。终点为恶心/呕吐、呼吸抑制和嗜睡，这些是常见的与吗啡相关的ADR。
在38例接受持续静脉/皮下吗啡输注的终末期HF患者中，14例（37%）出现ADR。发生ADR的患者的估计肾小球滤过率（eGFR）中位数低于未发生ADR的患者（分别为16[范围9-48]和41[范围8-133]；p=0.011）。发生率最高的ADR是嗜睡（n=13）、恶心/呕吐（n=5）和呼吸抑制（n=3）。发生ADR和未发生ADR的患者在吗啡维持剂量或给药持续时间方面无差异。基线eGFR为32 mL/min/1.73 m²是ADR预测的良好临界值（敏感性86%，特异性96%）。基线eGFR<32 mL/min/1.73 m²与吗啡相关ADR的发生显著相关（优势比6.63，95%置信区间1.19-37.01）。
我们的结果显示，37%接受持续静脉/皮下吗啡输注的终末期HF患者出现ADR，尤其是嗜睡。eGFR<32 mL/min/1.73 m²的患者可能会出现与吗啡相关的ADR。
