Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
Unit for Intractable Disease Care Unit, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
Acta Neurol Belg. 2024 Feb;124(1):101-107. doi: 10.1007/s13760-023-02344-5. Epub 2023 Aug 5.
While opioids have been found to be useful in relieving suffering in amyotrophic lateral sclerosis (ALS), there is a lack of evidence concerning how and how much to use them in practice. This study was conducted to clarify how opioids were used for patients with ALS.
We performed a retrospective case-based analysis at a single tertiary neurology center in Tokyo from 2010 to 2018. We enrolled patients with ALS who had died before the end of 2018. We examined the opioid dosage equivalent of morphine hydrochloride and patients' clinical backgrounds, focusing on ventilatory support.
Morphine was administered in 110 patients with ALS, and 84 were followed up until their death. Of these 84 patients, 57 (69.9%) did not use mechanical ventilation until death (no-MV group), and 21 (22.9%) utilized only non-invasive ventilation (NIV group). Final morphine dosage in the NIV group was significantly higher (mean 65.7 mg [SD 54.6], range 10-200 mg) than in the no-MV group (mean 31.7 mg [SD 26.9], range 0-120 mg; p = 0.015, Welch's t-test). The NIV group needed psychotropic drugs more frequently than the no-MV group (62% [n = 13] vs. 35% [n = 20]).
Patients in the NIV group used opioids for a statistically significantly longer time and at a higher dose than those in the no-MV group. Symptom control with opioids alone may be difficult, and the development of multifaceted evaluation and care is desirable.
阿片类药物已被证明在缓解肌萎缩侧索硬化（ALS）患者的痛苦方面有效，但在实践中如何以及使用多少阿片类药物缺乏证据。本研究旨在阐明阿片类药物在 ALS 患者中的使用情况。
我们在东京的一家三级神经病学中心进行了一项回顾性基于病例的分析，时间为 2010 年至 2018 年。我们纳入了 2018 年底前死亡的 ALS 患者。我们检查了盐酸吗啡的阿片类药物剂量当量以及患者的临床背景，重点是通气支持。
110 例 ALS 患者使用了吗啡，其中 84 例随访至死亡。在这 84 例患者中，57 例（69.9%）在死亡前未使用机械通气（无 MV 组），21 例（22.9%）仅使用无创通气（NIV 组）。NIV 组的最终吗啡剂量明显高于无 MV 组（平均 65.7mg[SD 54.6]，范围 10-200mg）（平均 31.7mg[SD 26.9]，范围 0-120mg；p=0.015，Welch's t 检验）。NIV 组比无 MV 组更频繁地需要精神药物（62%[n=13] vs. 35%[n=20]）。
NIV 组患者使用阿片类药物的时间和剂量均明显长于无 MV 组。单独使用阿片类药物控制症状可能很困难，需要制定多方面的评估和护理。
