Citron M L, Johnston-Early A, Fossieck B E, Krasnow S H, Franklin R, Spagnolo S V, Cohen M H
Am J Med. 1984 Aug;77(2):199-204. doi: 10.1016/0002-9343(84)90691-0.
To study the efficacy and safety of continuously administered intravenous morphine for cancer pain unrelieved by standard narcotic therapy, bolus intravenous injections of 2 to 5 mg of morphine were given every 10 minutes until pain relief was achieved. Within the next hour, continuous intravenous morphine infusion was begun with the hourly dose equal to the cumulative bolus dose. Respiratory rate, pulse, blood pressure, arterial blood gas values, mental status, and pain relief were recorded at baseline and during the study period. A reduction in arterial oxygen pressure (PaO2) and/or increase in arterial carbon dioxide pressure PaCO2 of more than 20 percent of baseline values occurred, during the first 24 hours of infusion, in a minority of patients. This did not require changes in hourly morphine dose. Despite subsequent increases in morphine dose, blood gas values tended to remain at or return toward baseline values. Severe toxicity occurred during one trial and was heralded by bradypnea and marked somnolence. Major pain relief was achieved in 11 of 15 trials. Therefore, continuous intravenous morphine is effective and safe therapy. Bradypnea associated with marked somnolence is a cause for dose reduction.
为研究持续静脉注射吗啡对标准麻醉治疗无法缓解的癌痛的疗效和安全性，每10分钟静脉推注2至5毫克吗啡，直至疼痛缓解。在接下来的一小时内，开始持续静脉输注吗啡，每小时剂量等于累积推注剂量。在基线和研究期间记录呼吸频率、脉搏、血压、动脉血气值、精神状态和疼痛缓解情况。在少数患者中，在输注的最初24小时内，动脉血氧分压（PaO2）降低和/或动脉血二氧化碳分压（PaCO2）升高超过基线值的20%。这并不需要改变每小时的吗啡剂量。尽管随后增加了吗啡剂量，但血气值往往保持在基线值或恢复到基线值。在一次试验中发生了严重毒性反应，表现为呼吸过缓和明显嗜睡。15次试验中有11次实现了主要的疼痛缓解。因此，持续静脉注射吗啡是一种有效且安全的治疗方法。伴有明显嗜睡的呼吸过缓是减少剂量的原因。
