天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (8): 861-864.doi: 10.11958/20180133

• 临床研究 • 上一篇    下一篇

主动应用吗啡治疗特发性肺间质纤维化的对照研究

宋忠花1 ， 张金庆2， 舒树苗3 ， 高炜4   

  1.  1山东省立第三医院呼吸肿瘤内科 （邮编250031）， 2普胸外科； 3天津中医药大学； 4天津医科大学肿瘤医院介入治疗科， 国家肿瘤临床医学研究中心
  • 收稿日期:2018-01-22 修回日期:2018-05-19 出版日期:2018-08-15 发布日期:2018-08-23
  • 通讯作者: 宋忠花 E-mail:16599946@qq.com

A controlled study of active application morphine in the treatment of idiopathic pulmonary fibrosis

SONG Zhong-hua1 , ZHANG Jin-qing 2, SHU Shu-miao3 , GAO Wei 4   

  1. 1 Department of Respiration, 2 Department of Thoracic Surgery, Shandong Provincial Third Hospital, Shandong 250031, China; 3 Tianjin University of Traditional Chinese Medicine; 4 Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer
  • Received:2018-01-22 Revised:2018-05-19 Published:2018-08-15 Online:2018-08-23

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摘要： 目的 观察主动应用吗啡治疗特发性肺间质纤维化 （IPF） 患者呼吸困难的有效性及安全性。方法 33例因明显的呼吸困难加重而住院治疗的IPF患者依入院先后顺序被分为观察组 （16例） 和对照组 （17例）。对照组给予呼吸支持、 糖皮质激素等常规治疗； 观察组在对照组基础上主动予以低剂量吗啡1 mg皮下注射， 每日3次， 住院期间全程给予。观察记录2组患者间入院后不同时间点视觉模拟量表 （VAS） 评分、 住院时间、 住院期间呼吸困难急性发作次数和累计糖皮质激素用量以及不良反应发生情况。结果 2组入院时VAS 评分差异无统计学意义， 观察组入院后第4天、 出院前2 d及出院时VAS评分均较对照组降低 （P＜0.05）； 2组平均住院时间差异无统计学意义 （P＞0.05）；观察组住院期间出现呼吸困难加重次数、 糖皮质激素累计处方剂量均较对照组减少 （P＜0.05）； 2组患者均未出现呼吸抑制相关不良反应， 观察组便秘比例大于对照组， 恶心比例小于对照组 （P＜0.05）。结论 主动应用吗啡治疗有助于缓解IPF相关呼吸困难， 且安全有效。

关键词: 吗啡, 肺纤维化, 呼吸困难, 临床方案

Abstract:  Objective To investigate the efficacy and safety of active application morphine in the treatment of idiopathic pulmonary fibrosis (IPF) with dyspnea. Methods A total of 33 IPF patients with severe dyspnea were enrolled in this study. They were divided into the observation group (16 cases) and the control group (17 cases) according to the order of admission. The control group received respiratory support, glucocorticoids and other conventional treatment, in the whole course of hospitalization, the observation group was treated with low dose of morphine 1 mg subcutaneous injection three times a day on the basis of control group. The visual analogue scale (VAS) score was recorded at different time points after admission. The length of hospital stay, the number of acute dyspnea, cumulative glucocorticoid dose and adverse reactions were recorded and compared between the two groups. Results There was no significant difference in VAS score in patients on admission between two groups. The VAS scores were significantly lower four days after admission, 2 days before discharge and at discharge in observation group than those of control group (P < 0.05). There was no significant difference in the length of hospital stay between two groups (P＞0.05). The number of acute dyspnea and cumulative glucocorticoid dose were significantly decreased in observation group than those of control group (P < 0.05). No adverse reactions related to respiratory depression were found in two groups. There were more patients with constipation symptoms in the observation group than those of control group. The nausea ratio was smaller in the observation group than that in the control group (P＜0.05). Conclusion The active application of morphine therapy can help to relieve dyspnea symptoms in IPF patients, and it is safe and effective.

Key words: morphine, pulmonary fibrosis, dyspnea, clinical protocols