Dickerhoff R, von Ruecker A
Hämatologie/Onkologie, Johanniter Kinderklinik St. Augustin.
Klin Padiatr. 1995 Nov-Dec;207(6):321-5. doi: 10.1055/s-2008-1046561.
About 70% of all patients with sickle cell disease suffer from pain crises. Pain crises are recurrent episodes of pain that range in severity from mild to severe, usually occur very abruptly and are often localized around joints. Pain crises are caused by vaso-occlusions in the vascular bed of the bone marrow, leading to necrosis, edema and increased pressure. For effective analgesia morphine or morphine analogues are often required. When treating a pain crisis the patient's complaints need to be taken seriously and analgesic therapy should be started promptly with analgesics in proportion to the severity of the patient's pain. With mild pain oral non-opioid analgesics are sufficient, in moderate pain they are given in combination with oral codeine. Severe pain requires IV morphine, also combined with a non-opioid analgesic. Intravenous morphine makes a thorough monitoring of ventilation and level of consciousness mandatory. Sickle cell patients do not become drug dependent if given morphine for adequate analgesia. While bone marrow transplantation has become an accepted treatment modality for sickle cell patients with severe pain crises, treatment with hydroxyurea to increase HbF levels and reduce incidence and severity of pain crises, however, is still experimental.
约70%的镰状细胞病患者会经历疼痛危象。疼痛危象是反复发作的疼痛，严重程度从轻到重不等，通常突然发作，且常局限于关节周围。疼痛危象是由骨髓血管床的血管阻塞引起的，导致坏死、水肿和压力升高。为有效镇痛，通常需要使用吗啡或吗啡类似物。治疗疼痛危象时，患者的主诉需得到认真对待，应根据患者疼痛的严重程度及时开始使用镇痛药进行镇痛治疗。轻度疼痛时，口服非阿片类镇痛药即可；中度疼痛时，可与口服可待因联合使用；重度疼痛则需要静脉注射吗啡，同时也需联合使用非阿片类镇痛药。静脉注射吗啡时，必须对通气和意识水平进行全面监测。镰状细胞病患者在接受足够镇痛剂量的吗啡治疗时不会产生药物依赖。虽然骨髓移植已成为镰状细胞病伴严重疼痛危象患者的一种公认治疗方式，但使用羟基脲提高HbF水平并降低疼痛危象的发生率和严重程度的治疗仍处于试验阶段。
