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疼痛控制是临终关怀治疗的最重要的目的之一,为此临床治疗过程中,鸦片的应用就很常见。然而,多少患者需要大剂量吗啡(HDM>299mg/d),这些患者的特征如何,以及大剂量吗啡应用是否影响患者的生存尚不明确。方法:作者对1996年1月到1997年10月入住该中心的所有651位住院病人病历进行了回顾性分析,收集了有关资料,包括患者的一般情况,医学诊断,疼痛控制,吗啡剂量,常规剂量外的补救剂量、联合止痛药的使用和辅助治疗,以及在临终病房与吗啡剂量有关的生存时间。结果:作者确认了453位接受吗啡治疗以解除疼痛患者。其中55位吗啡需要量超过299mg/d,吗啡剂量与年龄呈负相关性(r=-0.35,P=0.01)。男性患者和非白种人患者与其它人相比,需要稍大剂量的吗啡。原发性乳癌和泌尿生殖器肿瘤以及骨和脊髓转移者需要大剂量的吗啡。统计分析表明,最大剂量吗啡的对数与总的解救剂量之间呈正相关(r=0.03,P=0.05)。用大剂量吗啡患者的中位生存时间是15.6天,与用低剂量吗啡患者间无不同。结论:吗啡剂量与一些临床统计资料间存在着很强的相关性。没有观察到有意义的剂量限制性副作用。表明吗啡剂量有较强的临床安全范围。大剂量吗啡不影响患者生存时间,对剂量因素的认识将提高治疗和预测可能大剂量吗啡剂量的能力,因此,达到疼痛缓解?
Pain control is one of the most important purposes of end-of-life care treatment. For this clinical application, the use of opium is very common. However, how many patients require large doses of morphine (HDM > 299 mg/d), how the characteristics of these patients are, and whether the use of high-dose morphine affects the survival of patients is unclear. METHODS: The authors retrospectively analyzed the medical records of all 651 inpatients who were admitted to the center from January 1996 to October 1997. The data were collected, including the patient’s general condition, medical diagnosis, pain control, morphine dose, and routine. Remedy doses outside of dose, use of co-administered analgesics, and adjuvant therapy, and survival times associated with morphine doses in the terminal ward. RESULTS: The authors identified 453 patients who were treated with morphine to relieve pain. Of these, 55 morphine requirements exceeded 299 mg/d, and morphine dose was negatively correlated with age (r=-0.35, P=0.01). Male patients and non- Caucasian patients require slightly higher doses of morphine compared to others. Patients with primary breast and urogenital tumors and bone and spinal cord metastases require large doses of morphine. Statistical analysis showed that there was a positive correlation between the maximum dose of morphine and the total rescue dose (r = 0.03, P = 0.05). The median survival time for high-dose morphine patients was 15.6 days, which was no different from that of low-dose morphine patients. Conclusion: There is a strong correlation between morphine dose and some clinical statistics. No significant dose limiting side effects were observed. Shows that morphine dose has a strong clinical safety range. Large doses of morphine do not affect patient survival. Understanding of dose factors will increase the ability to treat and predict potentially large doses of morphine, and thus achieve pain relief.