吗啡应用于终末期肿瘤患者呼吸困难的安全性研究

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。

Safty of morphine in terminal cancer patients with dyspnea

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:Mor-phine group and non -morphine group.The improvement of dyspnea,adverse reactions and survival time were ob-served 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),re-spiratory rate,heart rate and oxygen saturation had no significant differences.Six cases of nausea and vomit,eleven ca-ses 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 man-agement in terminal cancer.It can significantly improve dyspnea and does not reduce the survival time of patients.