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The dose, efficacy, and side effects of continuous intravenous infusion (CIVI) of morphine were compared with continuous subcutaneous infusion (CSCI) of morphine in patients with chronic cancer pain. Eligible patients were referred to the Palliative Care Program and were receiving a stable dose of CIVI of morphine. The design was a within-patient, one-way crossover; in which each patient provided data before and after a switch from CIVI to CSCI of morphine. "Rescue" doses were 50% of the hourly dose given every 2 hours as needed. Morphine was infused intravenously (i.v.) and subcutaneously (s.c.) via a McGaw/AccuPro Volumetric Infusion Pump. After baseline data, including side effects and pain assessment, were obtained, patients were evaluated twice daily for toxicity and analgesic efficacy. Those who had a stable CIVI dose for 48 consecutive hr were crossed over to the CSCI at the same dose as the intravenous (i.v.) phase. A stable dose was defined as no dose change, four or less rescue doses in the previous 24 hr, and a pain rating of none or mild. CIVI was considered equal to CSCI if these criteria were maintained for 96 consecutive hr. Fifty-seven patients were entered, and 40 were evaluable (15 women and 25 men). The median age was 67 (range 30-83 years). All 40 participants, after maintaining a stable dose throughout the i.v. phase, crossed to the s.c. phase and remained on s.c. for at least 48 hr. Thirty-two patients maintained a stable dose throughout the i.v. and s.c. phases. The mean stable i.v. dose (day 2) was 5.05 mg/hr, and the mean stable s.c. dose (day 4) was 5.7 mg/hr (P = 0.01). The mean number of rescue doses on day 2 was 0.83 per 24 hr versus 0.80 per 24 hours on day 4 (P = 0.6). The mean categorical pain score on day 2 was 0.83, and on day 4, 0.85 (P = 0.7). The mean visual analogue scale (VAS) on day 2 was 22.9 mm versus 17.6 mm on day 4 (P = 0.1). The mean incidence of side effects on day 2 was 1.7, and on day 4, 2.0 (P = 0.2). No patient was withdrawn or had a dose reduction due to unacceptable toxicity. There were two reports of local toxicity (mild erythema) at the SC needle insertion point, which required a site change. All of our 40 patients had adequate pain control with CIVI and CSCI morphine. Of the eight participants who were not maintained on the same i.v. and s.c. dose, all had adequate pain control and a similar side-effect profile on a higher s.c. morphine dose. These data suggest that the i.v. and s.c. routes are equianalgesic for most patients when administered as a continuous infusion. Pain control and side-effect profiles are quite similar and acceptable. s.c. morphine is an excellent alternative to i.v. morphine in both inpatients and outpatients requiring parenteral morphine for pain.

译文

比较了慢性癌症疼痛患者中吗啡连续静脉输注(CIVI)与吗啡连续皮下输注(CSCI)的剂量,疗效和副作用。符合条件的患者被转到姑息治疗计划,并接受稳定剂量的吗啡CIVI。该设计是患者内部的单向交叉。其中每个患者提供了从吗啡从CIVI切换到CSCI之前和之后的数据。 “救援”剂量是根据需要每2小时给予的每小时剂量的50%。吗啡通过McGaw / AccuPro容量输注泵静脉内(i.v.)和皮下(s.c.)输注。获得包括副作用和疼痛评估在内的基线数据后,每天对患者进行两次毒性和止痛效果评估。连续48个小时具有稳定CIVI剂量的患者以与静脉内(i.v.)阶段相同的剂量转入CSCI。稳定剂量定义为无剂量变化,在过去24小时内有四个或更少的急救剂量,疼痛等级为无或轻度。如果连续96个小时保持这些标准,则认为CIVI等于CSCI。入组患者57例,其中40例可评估(女性15例,男性25例)。中位年龄为67岁(范围为30-83岁)。在整个静脉内维持稳定剂量后,所有40位参与者阶段,跨到南卡罗来纳州相并保持在s.c.至少持续48小时。在整个静脉内,有32名患者维持了稳定的剂量。和s.c.阶段。平均稳定i.v.剂量(第2天)为5.05 mg / hr,平均稳定s.c.剂量(第4天)为5.7 mg / hr(P = 0.01)。第2天的平均急救剂量为每24小时0.83,而第4天为每24小时0.80(P = 0.6)。第2天的平均类别疼痛评分为0.83,第4天的平均疼痛评分为0.85(P = 0.7)。第2天的平均视觉模拟量表(VAS)为22.9毫米,而第4天为17.6毫米(P = 0.1)。第2天的副作用的平均发生率为1.7,而第4天的平均发生率为2.0(P = 0.2)。没有患者因不可接受的毒性而退出或剂量减少。有两份关于SC针插入点的局部毒性(轻度红斑)的报道,需要进行部位改变。我们所有的40名患者均通过CIVI和CSCI吗啡可以很好地控制疼痛。在没有保持相同i.v.的八位参与者中和s.c.剂量较高时,所有患者均具有足够的疼痛控制能力,并且在较高的s.c.下具有相似的副作用。吗啡剂量。这些数据表明和s.c.当以连续输注方式给药时,对于大多数患者而言,这些途径均具有镇痛作用。疼痛控制和副作用状况非常相似且可以接受。南卡罗来纳州吗啡是静脉注射的绝佳替代品。需要胃肠外吗啡治疗的住院患者和门诊患者中的吗啡疼痛。

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