Mercadante S, Caligara M, Sapio M, Serretta R, Lodi F
Department of Anesthesia and Intensive Care, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
J Pain Symptom Manage. 1997 Apr;13(4):241-4. doi: 10.1016/s0885-3924(97)00076-6.
Inoperable bowel obstruction in patients with renal failure is a difficult clinical situation. In the last days of life, an accumulation of morphine metabolites in patients with impaired renal function may cause opioid toxicity, including terminal agitation. The use of an alternative drug may prevent morphine metabolite accumulation in uremic patients. Fentanyl may be an alternative to morphine. It has a large apparent volume of distribution, a short plasma half-life, and extensive biotransformation without active metabolites. A patient with acute renal impairment and bowel obstruction was successfully treated with a subcutaneous continuous infusion of fentanyl (25 micrograms/hr) and boluses of 12.5 micrograms for the last 2 days of life, limiting the worsening of the dramatic clinical picture of bowel obstruction combined with renal impairment. No local toxicity was evidenced.
肾衰竭患者出现的不可手术的肠梗阻是一种棘手的临床情况。在生命的最后几天，肾功能受损患者体内吗啡代谢物的蓄积可能导致阿片类药物中毒，包括临终躁动。使用替代药物可能会防止尿毒症患者体内吗啡代谢物的蓄积。芬太尼可能是吗啡的替代品。它具有较大的表观分布容积、较短的血浆半衰期以及广泛的生物转化且无活性代谢物。一名急性肾功能损害合并肠梗阻的患者在生命的最后两天通过皮下持续输注芬太尼（25微克/小时）以及12.5微克的推注剂量成功得到治疗，限制了肠梗阻合并肾功能损害这一严重临床症状的恶化。未发现局部毒性。
