Abstract：
OBJECTIVE: Opioids can mitigate dyspnoea, but the efficacy of hydromorphone use for dyspnoea in patients with cancer is not well known.
METHODS: Patients with cancers with more than mild dyspnoea treated with subcutaneous injection of hydromorphone between March 2020 and February 2022 at Kitano Hospital (Osaka, Japan) were reviewed retrospectively. Only patients who could self-report their symptoms ≥3 days after the start of hydromorphone therapy were included. Dyspnoea severity was rated on a five-point scale (0: \'not bothersome\'; 1: \'mild\'; 2: \'moderate\'; 3: \'severe\'; 4: \'overwhelming\').
RESULTS: Fifteen patients (2 with moderate, 12 with severe and 1 with overwhelming dyspnoea) were deemed eligible. The median interval from the start of hydromorphone initiation to death was 19 (IQR, 11-37) days. Thoracic drainage and palliative sedation after the start of hydromorphone therapy was undertaken in three and two patients, respectively. At 3 days, the median score of the Dyspnoea Rating Scale was improved significantly from 3 to 2 compared with that at baseline (p=0.0023). The intensity of dyspnoea was improved in 11 patients (73%). Opioid-related adverse events were not observed within 3 days.
CONCLUSIONS: Using hydromorphone for dyspnoea in patients with cancer seems to be appropriate if morphine use is contraindicated.
METHODS: Patients with cancers with more than mild dyspnoea treated with subcutaneous injection of hydromorphone between March 2020 and February 2022 at Kitano Hospital (Osaka, Japan) were reviewed retrospectively. Only patients who could self-report their symptoms ≥3 days after the start of hydromorphone therapy were included. Dyspnoea severity was rated on a five-point scale (0: \'not bothersome\'; 1: \'mild\'; 2: \'moderate\'; 3: \'severe\'; 4: \'overwhelming\').
RESULTS: Fifteen patients (2 with moderate, 12 with severe and 1 with overwhelming dyspnoea) were deemed eligible. The median interval from the start of hydromorphone initiation to death was 19 (IQR, 11-37) days. Thoracic drainage and palliative sedation after the start of hydromorphone therapy was undertaken in three and two patients, respectively. At 3 days, the median score of the Dyspnoea Rating Scale was improved significantly from 3 to 2 compared with that at baseline (p=0.0023). The intensity of dyspnoea was improved in 11 patients (73%). Opioid-related adverse events were not observed within 3 days.
CONCLUSIONS: Using hydromorphone for dyspnoea in patients with cancer seems to be appropriate if morphine use is contraindicated.
摘要：
目的：阿片类药物可以缓解呼吸困难，但氢吗啡酮用于癌症患者呼吸困难的疗效尚不清楚。
方法：2020年3月至2022年2月在北野医院皮下注射氢吗啡酮治疗的轻度以上呼吸困难的癌症患者（大阪，日本）进行了回顾性审查。仅包括在开始氢吗啡酮治疗后≥3天可以自我报告其症状的患者。呼吸困难的严重程度按五点评分(0:“不麻烦”;1:“轻度”;2:“中度”;3:“严重”;4:“压倒性”)。
结果：15例患者（2例中度，12例严重，1例严重呼吸困难）被认为是合格的。从氢吗啡酮开始到死亡的中位间隔为19(IQR，11-37）天。3例和2例患者在开始氢吗啡酮治疗后进行胸腔引流和姑息性镇静。分别。在3天,与基线时相比,呼吸困难量表的中位评分从3分显著提高至2分(p=0.0023).11例患者（73%）呼吸困难强度得到改善。在3天内未观察到阿片类药物相关的不良事件。
结论：如果禁止使用吗啡，则在癌症患者中使用氢吗啡酮治疗呼吸困难似乎是合适的。
方法：2020年3月至2022年2月在北野医院皮下注射氢吗啡酮治疗的轻度以上呼吸困难的癌症患者（大阪，日本）进行了回顾性审查。仅包括在开始氢吗啡酮治疗后≥3天可以自我报告其症状的患者。呼吸困难的严重程度按五点评分(0:“不麻烦”;1:“轻度”;2:“中度”;3:“严重”;4:“压倒性”)。
结果：15例患者（2例中度，12例严重，1例严重呼吸困难）被认为是合格的。从氢吗啡酮开始到死亡的中位间隔为19(IQR，11-37）天。3例和2例患者在开始氢吗啡酮治疗后进行胸腔引流和姑息性镇静。分别。在3天,与基线时相比,呼吸困难量表的中位评分从3分显著提高至2分(p=0.0023).11例患者（73%）呼吸困难强度得到改善。在3天内未观察到阿片类药物相关的不良事件。
结论：如果禁止使用吗啡，则在癌症患者中使用氢吗啡酮治疗呼吸困难似乎是合适的。
