Meunier-Cartal J, Souberbielle J C, Boureau F
Hautes Etudes de Management Hospitalier, Bussy St. Georges, Hôpital Necker-Enfants Malades, Paris, France.
J Pain Symptom Manage. 1995 May;10(4):267-73. doi: 10.1016/0885-3924(95)00002-G.
Undertreatment of cancer pain with analgesic drugs is still a frequent problem in French hospitals. In the absence of good analgesic practices, the use of a so-called lytic cocktail, which combines a neuroleptic (chlorpromazine), an opioid (meperidine), and an antihistamine (promethazine) has become common during the terminal phase of the disease. The lytic cocktail (LC) has been subsequently denounced as a type of disguised euthanasia. The aim of our study was to examine the prescription of morphine and lytic cocktail for terminally ill patients in a 427-bed French general hospital during a 3-year period (1989-1991) that coincided with the beginning of a pain relief service. The study was performed in two steps: a chart review of the 841 deceased patients during the observation period and an examination of morphine and parenteral promethazine consumption from the hospital pharmacy. Data from both the charts and the pharmacy showed an inverse relationship between these treatments. Morphine consumption increased while LC consumption decreased. The number of deceased patients who received LC were 24.4% in 1989, 19.9% in 1990, and 6.6% in 1991 (P < 0.001 between 1990 and 1991). The number of deceased who received morphine were 13.6% in 1989, 20.6% in 1990, and 23.9% in 1991 (P < 0.01 between 1989 and 1990). During the same period, the annual hospital morphine consumption increased by 191%, and the annual hospital parenteral promethazine consumption decreased by 62.5%. Our results suggest that, when pain is more correctly treated, the use of an inappropriate method of symptom control decreases.(ABSTRACT TRUNCATED AT 250 WORDS)
在法国医院，使用镇痛药对癌症疼痛治疗不足仍是一个常见问题。在缺乏良好镇痛措施的情况下，一种所谓的“溶解放松合剂”（它将一种抗精神病药（氯丙嗪）、一种阿片类药物（哌替啶）和一种抗组胺药（异丙嗪）混合在一起）在疾病终末期的使用变得很普遍。溶解放松合剂（LC）随后被指责为一种变相安乐死。我们研究的目的是调查一家拥有427张床位的法国综合医院在为期3年（1989 - 1991年）期间，与一项疼痛缓解服务开始时间相吻合时，为临终患者开具吗啡和溶解放松合剂的情况。该研究分两步进行：对观察期内841名死亡患者的病历进行回顾，以及调查医院药房吗啡和非肠道用异丙嗪的消耗量。病历和药房的数据均显示这两种治疗方法之间呈反比关系。吗啡消耗量增加，而溶解放松合剂消耗量减少。1989年接受溶解放松合剂治疗的死亡患者比例为24.4%，1990年为19.9%，1991年为6.6%（1990年和1991年之间P < 0.001）。1989年接受吗啡治疗的死亡患者比例为13.6%，1990年为20.6%，1991年为23.9%（1989年和1990年之间P < 0.01）。在同一时期，医院吗啡的年消耗量增加了191%，医院非肠道用异丙嗪的年消耗量减少了62.5%。我们的结果表明，当疼痛得到更正确的治疗时，不适当的症状控制方法的使用就会减少。（摘要截选至250字）
