Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone
Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone
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DOI：
10.1016/0885-3924(96)00050-4
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发表时间：
1996-09-01
影响因子：
4.7
通讯作者：
Parker, D
中科院分区：
文献类型：
--
作者：
Maddocks, I;Somogyi, A;Parker, D
我们观察到，在南方社区临终关怀计划的患者中，高达25%的患者在接受吗啡治疗时出现急性精神错乱，当阿片类药物改为羟考酮或芬太尼时，情况有所改善。这项研究旨在通过一项前瞻性试验证实羟考酮在此类患者中产生的精神错乱比吗啡更少。羟考酮通过持续的皮下输注给予，因为这允许更灵活和可靠的剂量，并监测患者对药物的任何不良反应。13名患者完成了这项研究。在从吗啡改为羟考酮后，精神状态以及恶心和呕吐的统计上有了显著的改善。疼痛评分有所改善，但没有达到统计学意义上的水平。检测患者的表型状态，以确定他们代谢羟考酮的能力。一名没有达到足够的疼痛控制的患者被证明是一个糟糕的代谢者。这些结果表明，羟考酮皮下注射对吗啡所致的神志不清患者可提供有效的镇痛作用，且无明显副作用。这种治疗使患者在生命的最后几天保持更舒适和清醒；少数不能有效代谢羟考酮的患者可能得不到这种好处。
We have observed among patients of the Southern Community Hospice Programme that up to 25% experience acute delirium when treated with morphine and improve when the opioid is changed to oxycodone or fentanyl. This study aimed to confirm by a prospective trial that oxycodone produces less delirium than morphine in such patients. Oxycodone was administered by a continuous subcutaneous infusion, as this allowed more flexible and reliable dosing, and patients were monitored for any adverse reactions to the drug. Thirteen patients completed the study. Statistically significant improvements in mental state and nausea and vomiting occurred following a change from morphine to oxycodone. Pain scores improved but did not reach a level of statistical significance. The phenotype status of the patients was tested to establish their capacity to metabolize oxycodone. One patient who did not achieve adequate pain control proved to be a poor metabolizer. These results show that oxycodone administered by the subcutaneous route can provide effective analgesia without significant side effects in patients with morphine-induced delirium. This treatment allows patients to remain more comfortable and lucid in their final days; A smalt proportion of patients who do not metabolize oxycodone effectively may not receive this benefit.