纳洛酮治疗晚期癌症患者阿片类药物过量15例临床分析

Opioid overdose in advanced cancer patients antagonized by naloxone: a report of 15 cases

目的：分析纳洛酮治疗晚期癌症患者阿片类药物过量的临床特点。方法：晚期癌痛患者15例，其中5例接受芬太尼透皮贴剂，6例接受硫酸吗啡缓释片，4例接受盐酸羟考酮缓释片行止痛过程中出现药物过量表现，立即应用纳洛酮施治，观察和分析出现药物过量的原因、应用纳洛酮后的治疗反应以及患者总体预后。结果：本组患者等效吗啡片剂量10～640 mg/d，中位剂量360 mg/d；纳洛酮救治剂量为0.2～0.8 mg，中位剂量0.4 mg；用药后，患者瞳孔在数分钟后最先恢复正常，10-30 min后呼吸抑制逐步改善，血压需要1h以上逐渐恢复至先前水平；2例患者应用芬太尼透皮贴剂过量前发热，3例患者近期肝功能指标恶化明显，7例患者之前癌痛控制不佳，在阿片类药物滴定过程中出现过量；患者总体预后差，总中位生存时间仅为1.9个月。结论：晚期癌痛患者阿片类药物过量并不罕见，应用纳洛酮救治安全有效，应提高警惕、尽早诊断、及时救治，以免影响止痛治疗的顺利实施。

Objective： To analyze the clinical characteristics of opioid overdose in naloxone-antagonized advanced cancer pa-tients. Methods：Fifteen patients with moderate to severe cancer pain were diagnosed with opioid overdose. Five of the patients were treated with transdermal fentanyl, six with prolonged-release morphine sulfate tablets, and four with prolonged-release oxycodone hy-drochloride tablets. Naloxone was immediately administered upon discovery of opioid overdose. The reasons behind opioid overdose as well as the naloxone efficacy and patient prognosis were investigated. Results：In the patients of the group, the equivalent dosage of morphine, the treatment dosage is 10 mg/d to 640 mg/d, and the median dosage is 360 mg/d. The therapeutic dose of naloxone is 0.2 mg to 0.8 mg, and the median dosage is 0.4 mg. After naloxone use, the pupils of the patients were recovered in the first few min-utes, and respiratory depression improved within 10 min to 30 min. However, blood pressure recovery was slow for at least 1 hour. Two fever-afflicted patients were diagnosed with transdermal fentanyl overdose and impaired liver function, which exhibited rapid deteriora-tion immediately before the opioid overdose. Seven patients with poor pain control were diagnosed with opioid overdose during drug ti-tration. These patients were given poor prognosis, and their median overall survival time was 1.9 months. Conclusion： Opioid over-dose, which is shown to be common in advanced cancer patients, can be safely and effectively treated by naloxone. Early diagnosis and treatment of this condition would significantly improve the quality of pain control for the patient.