Itopride Ua kom muaj txiaj ntsig ntawm Kev Tswj Xyuas Ntawm Opioid-Induced cem quav nyob rau hauv Palliative Care Cov neeg mob: Kev Tshawb Fawb Kev Tshawb Fawb Tsis-InterventionalⅡ
Oct 31, 2023
Cov txiaj ntsig
Cov pejxeem tau kawm
Cov ntaub ntawv ntawm 130 cov neeg mob tau sau tseg. cuaj caum-ob tus neeg mob tau ntsib cov txheej txheem suav nrog (poj niam 54.3%) thiab tau tshuaj xyuas plaub pawg: OXN + ITP (N=9), ITP (N=11), OXN (N {{7}) }), thiab CTRL(N=61). Txoj kev tshawb no tau nthuav tawm hauv daim duab 1.Cov pab pawg tsis sib txawv ntawm kev sib deev, hnub nyoog, kev kuaj mob, thiab qhov ncauj morphine sib npaug ntawm cov neeg muaj zog opioids hnub 0 thiab hnub 7. Cov tshuaj opioids siv cov nram qab no: morphine (qhov ncauj lossis parenteral), oxycodone , fentanyl, buprenorphine, thiab tapentadol.Cov lus qhia txog pej xeem tau nthuav tawm hauv Table II.
Cov tsos mob ntawm cem quav
Kev tiv thaiv laxative lossis kev kho mob txhawm rau ua kom tiav tsawg kawg peb lub plab zom mov lub lim tiam thiab qhov kev siv tau ntawm cov tsos mob plab, thiab lub hom phiaj no tau ua tiav hauv txhua pawg. Tsis muaj qhov sib txawv ntawm cov ntaub ntawv tshawb fawb txog qhov tseem ceeb ntawm cov pab pawg ntawm cov tsos mob ntawm cem quav (Table III).Eighty-ob (89%) cov neeg mob tau kuaj pom tias cem quav, nrog qhov sib txawv tsis tseem ceeb ntawm cov pab pawg. Txawm li cas los xij, cov tswv yim los tiv thaiv cem quav tau tshwm sim ua tiav, qhov nruab nrab, nyob rau hauv tag nrho plaub pawg.Zuag qhia tag nrho, kev tshem tawm cov quav tau ua hauv 4 tus neeg mob tau txais cov tshuaj laxative nkaus xwb, thiab tsis nyob hauv lwm pab pawg. Enemas tau siv rau hauv 16 tus neeg mob, thiab 14 ntawm lawv nyob hauv pawg tswj hwm.
Qhov txo qis ntawm kev siv laxative
Txawm hais tias tsis muaj qhov sib txawv ntawm cov pab pawg hais txog cov tsos mob ntawm plab lossis qhov zaus ntawm kev txav ntawm lub plab, qhov tsim nyog ntawm cov tshuaj txo qis hauv cov pab pawg uas siv itopridewas (Kruskal-Wallis ANOVA p=0.0027) . Hauv pawg ITP, qhov yuav tsum tau siv cov tshuaj laxative txo qis los ntawm 0.64 (–{15}}.64; 95% CI: –1.6–1.8) thiab hauv pawg OXN + ITP los ntawm 0. 67 (–{34}}.67; 95% CI: –1.5–1.7) hauv qhov ntsuas 0–4. Cov txiaj ntsig no yuav zoo li tsis tseem ceeb, tab sis lawv tau sib txawv (Mann-Whitney U test) los ntawm oxycodone/naloxone (ITP vs. OXN p=0.009, OXN + ITP vs. OXNp=0.017) thiab pawg tswj (ITP vs. CTRLp=0.010, OXN + ITP vs. CTRL p=0.0.25). Tsis muaj kev txo qis hauv kev siv tshuaj laxative hauv cov neeg mob noj oxycodone/naloxone vs. pawg tswj hwm (p=0.22) (Daim duab 2).
Cov teebmeem tsis zoo
Txoj kev tshawb no yog ib qho kev soj ntsuam rov qab ntawm cov txheej txheem keeb kwm ntawm cov neeg mob, thiab tsis muaj 130 tus neeg mob tau tshaj tawm cov kev mob tshwm sim. Qhov no tsis txhais tau hais tias tsis muaj qhov cuam tshuam tsis zoo ntawm kev kho mob, tab sis yog tias lawv tau raug mob me me lossis nruab nrab, yog li nws tsis tas yuav tsum muaj.sary los qhia lawv hauv cov ntaub ntawv niaj hnub. Tsis muaj tus neeg mob nres siv itopride nruab nrab ntawm hnub {{0}} thiab hnub 7. Txawm hais tias cov xwm txheej uas itopride tau siv rau hnub 0 raug tshem tawm los ntawm kev tshuaj xyuas, tsis muaj ib tus neeg mob tau tso tseg itopride tom qab 7 hnub. Yog li, nws tuaj yeem suav tau tias cov tshuaj tau txais txiaj ntsig zoo.Cov keeb kwm tom qab hnub 7 tsis tau txheeb xyuas.
Kev sib tham
Qhov no yog ib qho kev tshawb fawb tsis muaj kev cuam tshuam, nrog rau tag nrho cov kev txwv uas tsis yog-randomized soj ntsuam trialsbear. Txawm li cas los xij, nws qhov txiaj ntsig yog qhov txiaj ntsig tag nrho hauv ib puag ncig tiag tiag, thaum siv itopride ua anelement ntawm laxative tiv thaiv thiab kev kho mob.Qhov no yog thawj zaug kev soj ntsuam daim ntawv qhia tsom ncaj qha ntawm kev siv itopride hauv OIC.Cov kws kho mob tsis koom nrog hauv kev tsom xam thiab tsuas yog nug. los muab cov ntaub ntawv tsim kho yam tsis muaj lub hom phiaj kev kawm tshwj xeeb, txhawm rau txwv tsis pub muaj kev tsis ncaj ncees.
Lawv xa cov ntawv nug tsis hais txog lawv cov kev kho mob laxative thiab kev siv prokinetics. Nws kuj tseem piav qhia txog kev tshaj tawm ntawm pawg tswj hwm, vim tias feem ntau cov neeg mob tau txais cov tshuaj laxatives tsis tu ncua, thiab cov neeg tsawg tau raug kho nrog oxycodone / naloxone lossis itopride.Cov ntaub ntawv sau tau txaus kom ua tiav cov ntaub ntawv txheeb xyuas qhov tseeb.Tsis muaj qhov sib txawv ntawm cov pawg kawm hauv Cov ntsiab lus ntawm lub hnub nyoog, poj niam txiv neej, thawj qhov kev kuaj mob, kev ua tau zoo (ECOG), opioids siv, lossis kev siv cov tsos mob ntawm cem quav ntawm cov pab pawg.
Ua raws li cov lus qhia saum toj no, txhua tus neeg mob tau txais opioid analgesics yuav tsum tau txais cem quav los ntawm kev siv cov tshuaj laxative los yog siv opioidsin ua ke nrog antagonists (xws li oxycodone / naloxone) [2, 3]. Cov lus qhia Polish qhia tias ntxiv prokinetics tuaj yeem ua rau muaj txiaj ntsig zoo ntawm kev kho laxative, tab sis tsis muaj pov thawj kev kho mob ncaj qha rau qhov ntawd [14]. Raws li cov lus qhia no, txheeb xyuas hauv ib qho chaw nruab nrabhort txoj kev tshawb no [7], kev tiv thaiv ntawm OIC yuav tsum tau muab nrog ib qho kev mob siab uas ua kom lub plab zom mov tsawg kawg peb zaug hauv ib lub lis piam thiab kev tswj xyuas cov tsos mob ntawm plab hnyuv.
Lub hom phiaj no tau ua tiav hauv txhua pawg neeg kawm, uas tsis txawv ntawm ib leeg nyob rau hauv cov nqe lus ntawm kev siv cov tsos mob ntawm cem quav. Hauv lwm lo lus, tag nrho plaub lub tswv yim zoo sib xws hauv kev tiv thaiv OIC: (1) itopride ntxiv rau cov tshuaj laxatives, (2) oxycodone / naloxone siv nrog cov tshuaj laxatives, (3) oxycodone / naloxone thiab itopride ntxiv cov tshuaj tolaxatives, lossis (4) cov tshuaj laxative nkaus xwb. . Nws tau ua tiav los ntawm kev siv tshuaj laxative yog tias tsim nyog.
Qhov kev tshawb pom tseem ceeb ntawm txoj kev tshawb no yog tias ntxiv itopride rau kev kho laxative txo qis qhov yuav tsum tau siv laxatives. Ntawm qhov tod tes, kev siv oxycodone / naloxone tsis cuam tshuam rau kev siv cov tshuaj laxative.Dab tsi ntxiv, kev sib xyaw ua ke ntawm oxycodone / naloxone thiab itopride tsis tau ua kom muaj txiaj ntsig zoo ntawm kev tswj hwm kev tiv thaiv ntawm OIC.Cov kev tshawb pom tau lees paub cov pov thawj tsis tshua muaj kev kho mob muaj. Tam sim no [31].
Hauv kev xaus, txhua lub tswv yim ntawm OIC kev tiv thaiv zoo sib npaug zoo hauv kev kho mob. Itopride, tab sis tsis yog naloxone, tau tshwm sim hauv kev txo qis kev siv tshuaj laxative hauv OIC. Txawm li cas los xij, kev siv oxycodone / naloxone lossis itopride tuaj yeem cuam tshuam nrog kev txo qis qhov tsim nyog ntawm kev cuam tshuam thiab cov txheej txheem, xws li kev tshem tawm cov quav los yog enemas.
Cov lus xaus yuav tsum tau ceev faj vim tias nws tsis yog qhov kev tshawb nrhiav qhov muag tsis pom.Peb yuav tsum kho cov txiaj ntsig no ua ntej. Wesuggest tias RCT yuav muaj txiaj ntsig los lees paub tus nqi ntawm itopride hauv lub tswv yim ntawm kev tiv thaiv thiab kho OIC.
Ntuj Herbal Tshuaj Rau Relieving cem quav-Cistanche
Cistanche yog ib tug genus ntawm parasitic nroj tsuag uas belongs rau tsev neeg Orobanchaceae. Cov nroj tsuag no paub txog lawv cov khoom siv tshuaj thiab tau siv hauv Cov Tshuaj Suav Tshuaj (TCM) rau ntau pua xyoo. Cov hom Cistanche feem ntau pom muaj nyob hauv thaj av qhuav thiab suab puam ntawm Tuam Tshoj, Mongolia, thiab lwm qhov chaw ntawm Central Asia. Cistanche nroj tsuag yog tus cwj pwm los ntawm lawv cov nqaij tawv, yellowish stems thiab muaj nuj nqis heev rau lawv cov txiaj ntsig kev noj qab haus huv. Hauv TCM, Cistanche ntseeg tau tias muaj cov khoom siv tonic thiab feem ntau yog siv los kho lub raum, txhim kho qhov tseem ceeb, thiab txhawb kev ua haujlwm ntawm kev sib deev. Nws kuj yog siv los daws cov teeb meem ntsig txog kev laus, qaug zog, thiab kev noj qab haus huv tag nrho. Thaum Cistanche muaj keeb kwm ntev ntawm kev siv tshuaj ib txwm siv, kev tshawb fawb tshawb fawb txog nws txoj kev ua tau zoo thiab kev nyab xeeb yog tsis tu ncua thiab txwv. Txawm li cas los xij, nws paub tias muaj ntau yam bioactive tebchaw xws li phenylethanoid glycosides, iridoids, lignans, thiab polysaccharides, uas tuaj yeem ua rau nws cov teebmeem tshuaj.
Wecistanche covcistanche hmoov, cistanche ntsiav tshuaj, cistanche capsules,thiab lwm yam khoom tsim los sivsuab puamcistancheraws li cov khoom siv raw, txhua yam muaj txiaj ntsig zoo rau kev tshem tawm cem quav. Cov txheej txheem tshwj xeeb yog raws li hauv qab no: Cistanche ntseeg tau tias muaj cov txiaj ntsig zoo rau kev tshem tawm cem quav raws li nws cov kev siv ib txwm siv thiab qee cov tshuaj uas nws muaj. Txawm hais tias kev tshawb fawb tshawb fawb tshwj xeeb ntawm Cistanche qhov cuam tshuam rau cem quav yog txwv, nws tau xav tias muaj ntau lub tswv yim uas yuav ua rau nws muaj peev xwm txo tau cem quav. Laxative nyhuv:Cistanchetau ntev tau siv nyob rau hauv tsoos suav tshuaj raws li ib tug tshuaj rau cem quav. Nws ntseeg tau tias muaj cov nyhuv laxative me me, uas tuaj yeem pab txhawb kev zom zaub mov thiab ua rau cem quav. Cov nyhuv no tuaj yeem raug ntaus nqi rau ntau lub tebchaw nyob hauv Cistanche, xws li phenylethanoid glycosides thiab polysaccharides. Moistening cov hnyuv: Raws li kev siv ib txwm siv, Cistanche suav hais tias muaj cov khoom siv moisturizing, tshwj xeeb yog tsom rau cov hnyuv. Txhawb nqa dej thiab lubrication ntawm cov hnyuv yuav pab tau cov cuab yeej soften thiab yooj yim dua, yog li no relieving cem quav. Anti-inflammatory Effect: cem quav tej zaum yuav txuam nrog o nyob rau hauv lub plab zom mov. Cistanche muaj qee qhov sib txuas, suav nrog phenylethanoid glycosides thiab lignans, uas ntseeg tau tias muaj cov tshuaj tiv thaiv kab mob. Los ntawm kev txo cov kab mob hauv cov hnyuv, nws tuaj yeem pab txhim kho kev zom zaub mov tsis tu ncua thiab txo qhov cem quav.
