吗啡应用于终末期肿瘤患者呼吸困难的安全性研究

Safty of morphine in terminal cancer patients with dyspnea

目的:回顾性分析使用吗啡治疗终末期肿瘤患者呼吸困难的安全性。方法:收集自2010年1月至2014年8月间,于上海第三人民医院肿瘤内科住院且具有完整随访资料的病人170例。按治疗情况,将患者分为吗啡治疗组(90例)、非吗啡治疗组(80例),记录吗啡治疗的不良反应,观察比较两组患者呼吸困难的改善情况、生存时间和不良反应。结果:两组患者的一般临床资料基本均衡。患者经吗啡治疗视觉模拟量表(VAS)值由治疗前(61.96±7.48)mm降低至治疗后(24.46±8.36)mm,差异有统计学意义(P<0.05),呼吸频率、心率及血氧饱和度治疗前后情况无差别(P>0.05)。吗啡组出现6例恶心、呕吐,11例便秘,1例呼吸抑制;非吗啡组出现3例恶心、呕吐,4例便秘。吗啡治疗组中位生存时间71.5天,非吗啡组中位生存时间为66.0天(P>0.05),两组之间无统计学差异。结论:吗啡治疗终末期肿瘤患者呼吸困难是安全有效的,能显著改善呼吸困难且不减少患者的生存时间。

Objective： To investigate the safty of morphine in the treatment of dyspnea appeared in patients with advanced cancer. Methods： From January 2010 to August 2014,we retrospectively collected clinical data from 170 terminal cancer patients with dyspnea. All patients were divided into two groups according to treatment regimen： Morphine group and non- morphine group. The improvement of dyspnea,adverse reactions and survival time were observed and compared. Results： There were no significant differences in characteristics and baseline of patients between two groups. After treatment,VAS values decreased from（ 61. 96 ± 7. 48） mm to（ 24. 46 ± 8. 36） mm（ P〈0. 05）,respiratory rate,heart rate and oxygen saturation had no significant differences. Six cases of nausea and vomit,eleven cases of constipation,one cases of respiratory depression in morphine group and three cases of nausea and vomit,four case of constipation in non- morphine group. The median survival time of morphine group and non- morphine group was 71. 5 days and 66. 0 days respectively（ P〈0. 05）. Conclusion： Morphine is safe and effective for dyspnea management in terminal cancer. It can significantly improve dyspnea and does not reduce the survival time of patients.