Low-Dose Morphine for Dyspnea in Terminally Ill Patients with Idiopathic Interstitial Pneumonias
Low-Dose Morphine for Dyspnea in Terminally Ill Patients with Idiopathic Interstitial Pneumonias
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DOI：
10.1089/jpm.2016.0432
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发表时间：
2017-08-01
影响因子：
2.8
通讯作者：
Inoue, Yoshikazu
中科院分区：
文献类型：
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作者：
Matsuda, Yoshinobu;Maeda, Isseki;Inoue, Yoshikazu
背景：呼吸困难在特发性间质性肺炎（IIP）患者中非常普遍。目的：本研究的目的是检查持续皮下注射吗啡治疗晚期IIP患者呼吸困难的有效性和安全性。背景/受试者：我们回顾性分析了接受持续皮下注射吗啡治疗呼吸困难的晚期IIP患者的病例。测量值：我们回顾了使用数字评定量表（NRS）和呼吸频率（RR）测量的呼吸困难严重程度之前和两个和四个小时后吗啡开始。我们对有无无创正压通气（NPPV）的患者进行了亚组分析。结果：25例患者纳入本研究。吗啡开始时和治疗后2小时和4小时的中位吗啡剂量分别为0.25、0.25和0.5mg/小时。与基线（7.08 +/- 2.33）相比，在开始使用吗啡后4小时（平均标准差：5.32 +/- 2.58，p=0.04）但不超过2小时（5.52 +/- 2.43，p=0.11），呼吸困难NRS显著降低。与基线相比，RR在治疗后2或4小时均无显著变化。吗啡开始后的中位生存时间为47小时。与基线相比，未使用NPPV的患者在治疗后2小时和4小时的呼吸困难均显着改善，尽管使用NPPV的患者在吗啡治疗后无显着改善。两个亚组的RR均无显著变化。结论：吗啡可改善晚期IIP患者的呼吸困难，而不降低RR。
Background: Dyspnea is highly prevalent in patients with idiopathic interstitial pneumonias (IIPs). Objective: The objective of this study is to examine the effectiveness and safety of continuous subcutaneous morphine for dyspnea in terminally ill IIP patients. Setting/Subjects: We retrospectively reviewed cases of terminally ill IIP patients who received continuous subcutaneous morphine for dyspnea. Measurements: We reviewed dyspnea severity measured using numerical rating scale (NRS) and respiratory rate (RR) before and two and four hours after morphine initiation. We conducted subgroup analyses of patients with and without noninvasive positive pressure ventilation (NPPV). Results: Twenty-five patients were included in this study. Median morphine dose at morphine initiation and two and four hours after treatment was 0.25, 0.25, and 0.5mg/hour, respectively. Dyspnea NRS decreased significantly four hours after (meanstandard deviation: 5.32 +/- 2.58, p=0.04) but not two hours (5.52 +/- 2.43, p=0.11) after morphine initiation compared with baseline (7.08 +/- 2.33). RR did not change significantly either two or four hours after treatment compared with baseline. The median survival after morphine initiation was 47 hours. Patients who were not using NPPV showed significantly improved dyspnea both two and four hours after treatment compared with baseline, although patients who used NPPV showed no significant improvement with morphine. RR did not significantly change in either subgroup. Conclusions: Morphine might improve dyspnea in terminally ill IIP patients without decrease in RR.