Nakamura Tomohiro, Nakamura Mari, Kai Mayumi, Shibasaki Yumiko, Tomita Haruki, Watabe Miku, Yokokura Hatsumi, Momomura Shin-Ichi
Department of Internal Medicine, Saitama Citizens Medical Center Saitama Japan.
Department of Pharmacy, Saitama Citizens Medical Center Saitama Japan.
Circ Rep. 2023 Aug 31;5(9):351-357. doi: 10.1253/circrep.CR-23-0059. eCollection 2023 Sep 8.
For patients with advanced heart failure, palliative care, including opioids, is needed as a treatment for refractory dyspnea. However, little evidence has been reported on the efficacy and safety of opioids, and their use is not well established. We have introduced a protocol for the use of opioids for dyspnea in patients with advanced heart failure admitted to Saitama Citizens Medical Center. Following this protocol, differences in clinical variables and outcome were investigated between patients in whom opioids were initiated intravenously or subcutaneously (i.v./s.c. group; n=13) and patients in whom they were initiated orally (oral group; n=18). In a comparison of baseline characteristics, significantly more patients in the oral group had a history of hospitalization for heart failure within the past year, and significantly more patients were treated with dobutamine and tolvaptan. After initiation of opioid treatment, both groups showed improvement in dyspnea; however, serial changes in vital signs were significantly greater in the i.v./s.c. group. The survival rate was significantly higher in the oral group (P<0.0001), with 33% of patients discharged alive. The clinical use of oral opioids using a single-center protocol is reported, suggesting that oral opioids may be practical and effective for dyspnea in patients with advanced heart failure.
对于晚期心力衰竭患者，需要姑息治疗，包括使用阿片类药物，以治疗难治性呼吸困难。然而，关于阿片类药物的疗效和安全性的报道很少，其使用尚未得到充分确立。我们已经引入了一项在埼玉市民医疗中心收治的晚期心力衰竭患者中使用阿片类药物治疗呼吸困难的方案。按照该方案，对静脉或皮下注射阿片类药物起始治疗的患者（静脉/皮下组；n = 13）和口服阿片类药物起始治疗的患者（口服组；n = 18）之间的临床变量和结局差异进行了调查。在基线特征比较中，口服组中过去一年内有心力衰竭住院史的患者明显更多，接受多巴酚丁胺和托伐普坦治疗的患者也明显更多。开始阿片类药物治疗后，两组的呼吸困难均有改善；然而，静脉/皮下组生命体征的系列变化明显更大。口服组的生存率明显更高（P<0.0001），33%的患者存活出院。本文报道了使用单中心方案口服阿片类药物的临床应用情况，表明口服阿片类药物可能对晚期心力衰竭患者的呼吸困难实用且有效。
