OPIOID ROTATION FOR TOXICITY REDUCTION IN TERMINAL CANCER-PATIENTS
OPIOID ROTATION FOR TOXICITY REDUCTION IN TERMINAL CANCER-PATIENTS
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DOI：
10.1016/0885-3924(95)90924-c
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发表时间：
1995-07-01
影响因子：
4.7
通讯作者：
SUAREZALMAZOR, M
中科院分区：
文献类型：
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作者：
DESTOUTZ, ND;BRUERA, E;SUAREZALMAZOR, M
类阿片活性（毒性）代谢物的积累可能解释了长期使用高剂量时类阿片毒性的情况。阿片类药物晚期毒性的其他机制可能在受体水平上发现。无论原因如何，使用等镇痛剂量的阿片类药物的变化可以预期改善某些患者的毒性症状，同时保持疼痛控制。我们回顾了埃德蒙顿总医院姑息治疗病房的患者使用该技术的经验。在191例患者中，80例因认知障碍、幻觉、肌阵挛、恶心和呕吐、局部毒性和持续疼痛接受阿片类药物轮换（OR）。80例患者中58例（73%）的主要症状改善，P < 0.01。在显著低于预期等效镇痛剂量（OR前577 +/- 1535 mg vs OR后336 +/- 593 mg，P <0.04）的剂量下，根据10 cm视觉模拟量表（VAS）测量的疼痛控制从4.4 +/- 2.3改善至3.6 +/- 2.0（P <0.004）。我们的结论是阿片类药物毒性的症状可以缓解或，并选择两种或三种不同的阿片类药物是必要的，以获得满意的长期疼痛控制。
Accumulation of active (toxic) metabolites of opioids might explain cases of opioid toxicity when high doses are used for long periods of time. Other mechanisms of late toxicity of opioids may be found at the receptor level Whatever the cause a change of opioids using equianalgesic doses can be expected to improve symptoms of toxicity in some patients, while maintaining pain control. We reviewed the experience with this technique in patients admitted to the Palliative Care Unit of the Edmonton General Hospital. Of 191 patients, 80 underwent opioid rotation (OR) for cognitive failure, hallucinations, myoclonus, nausea and vomiting, local toxicity, and persistent pain. These leading symptoms improved in 58/80 patients (73%, P < 0.01). Pain control, as measured on a 10-cm visual analogue scale (VAS) improved from 4.4 +/- 2.3 to 3.6 +/- 2.0 (P < 0.004) at a dose significantly lower than that predicted to be equianalgesic (577 +/- 1535 mg before OR versus 336 +/- 593 mg after OR, P < 0.04). We conclude that symptoms of opioid toxicity can be relieved by OR, and that a choice of two or three different opioids is necessary to obtain satisfactory long-term pain control.