Itopride Ua kom muaj txiaj ntsig ntawm Kev Tswj Xyuas Opioid-induced cem quav hauv Palliative Care Cov neeg mob: Kev Tshawb Fawb Kev Tshawb Fawb Tsis yog kev cuam tshuam Ⅰ

Taw qhia: Nws tau pom zoo kom siv tshuaj laxatives niaj hnub rau kev tiv thaiv ntawm opioid-induced cem quav (OIC). Cov pov thawj txhawb nqa kev ua tau zoo ntawm prokinetics rau qhov kev qhia no tsis muaj tseeb. Txoj kev tshawb no tsom xyuas yog tias itopride, ntxiv rau kev tiv thaiv OIC txoj kev kho, ua kom muaj txiaj ntsig ntawm kev tiv thaiv kev cem quav opioid hauv cov neeg laus palliative care cov neeg mob.

Cov ntaub ntawv thiab cov txheej txheem: Hauv daim ntawv nug-raws li kev soj ntsuam, cov neeg mob txhua tus tau txais cov tshuaj laxatives ntxiv rau ib qho ntawm cov hauv qab no: oxycodone/naloxone (OXN); itopride (ITP); los yog oxycodone / naloxone + itopride (OXN + ITP). Qhov kev ntsuas tseem ceeb yog qhov txo qis ntawm qhov tsim nyog ntawm kev siv laxative ntawm 0-4 ntsuas tom qab 7 hnub ntawm kev kho mob.

Nyem rau tej yam ntuj tso tshuaj rau cem quav

Cov txiaj ntsig: Cuaj caum-ob tus neeg mob tau ntsib cov txheej txheem suav nrog hauv plaub pawg: OXN (n=12), ITP (11), OXN + ITP (9), thiab pawg tswj hwm (cov tshuaj laxatives tsuas yog xav tau) (60). Qhov tsim nyog ntawm cov tshuaj laxative txo qis hauv cov pab pawg uas siv itopridews, nrog rau qhov sib txawv tseem ceeb ntawm kev tswj hwm, oxycodone/naloxone (p=0.009), los yog ua ke. OXN tsis txo qis kev siv tshuaj (p=0.22).

Cov lus xaus: Txhua qhov kev cuam tshuam tau tshwm sim zoo sib xws hauv kev tiv thaiv OIC. Txawm li cas los xij, ntxiv itopride, tab sis tsis yog oxycodone / naloxone, ua rau txo qis qhov tsim nyog ntawm kev siv tshuaj laxative hauv OIC cov neeg mob, thiab nws zoo li muaj txiaj ntsig zoo hauv qhov xwm txheej no feem ntau refractory. Randomized, tswj kev sim yuav muaj txiaj ntsig kom tau txais cov ntaub ntawv pov thawj zoo yam tsis muaj kev tsis ncaj ncees.

Taw qhiakev txiav txim

Opioid analgesics yog lub hauv paus tseem ceeb ntawm kev tswj qhov mob hauv cov neeg mob qog noj ntshav [1–3]. Txawm li cas los xij, txawm tias ob peb hnub ntawm kev kho mob opioid tuaj yeem ua rau mob plab hnyuv loj. Opioid-induced cem quav (OIC) cuam tshuam txog 42.4% ntawm cov neeg mob oncology kawg thiab yog ib qho ntawm cov tsos mob tshwm sim ntau dua li qhov mob thiab cachexia hauv cov neeg mob no [4]. OIC tau txhais nyob rau hauv Rome IV Diagnostic Criteria raws li cov tsos mob tshiab los yog phem zuj zus ntawm constipation thaum pib, hloov, lossis nce kev kho opioid, uas yuav tsum muaj ob lossis ntau dua ntawm cov tsos mob uas txhais tau tias cem quav.

Cov txheej txheem yuav tsum tau ua tiav rau 3 lub hlis dhau los nrog cov tsos mob tshwm sim tsawg kawg 6 lub hlis ua ntej kuaj mob [5, 6]. Txawm li cas los xij, lub sijhawm ntev ntawm kev soj ntsuam no tsis muaj peev xwm ua tau rau cov neeg mob palliative feem ntau vim tias txoj kev ciaj sia nyob hauv ntau zaus yog luv dua. Tias yog vim li cas lub koom haum Polish ntawm PalliativeMedicine pom zoo 7 hnub ntawm kev soj ntsuam kom txaus rau txoj cai kev txiav txim siab ntawm kev kho mob laxative, uas tau ua pov thawj hauv cov txheej txheem validation kom ua tau zoo [7].Constipation yog ib qho teeb meem tsis zoo ntawm opioids vim nws tsis tso tseg. , tab sis augments nrog nce lub sij hawm ntawm kev kho opioid.

OIC tsis yooj yim rau kev tswj hwm, thiab kev ua haujlwm ntawm cov tshuaj laxative tsis zoo [2, 3, 8]. Hauv 85-95% ntawm cov neeg mob, cem quav ua rau txo qis kev noj qab haus huv ntawm lub neej, txawm hais tias ob feem peb yog qhov mob me thiab nruab nrab [9]. Kev cem quav kuj tseem ua rau muaj kev cuam tshuam nyiaj txiag ntxiv rau kev noj qab haus huv [10] .Kev ua haujlwm tsis zoo OIC yog qhov cuam tshuam tseem ceeb rau kev tswj xyuas qhov mob. Txhua tus neeg mob thib kaum xav tau kev hloov pauv ntawm cov tshuaj analgesic, thiab ib nrab ntawm cov neeg mob cem quav tau txais cov tshuaj tua kab mob zoo tshaj plaws vim kev mob plab hnyuv [11]. Cov neeg mob uas kho opioid feem ntau yuav siv kev kho mob cem quav piv nrog cov tsis tau txais opioids [12].

Nws raug pom zoo, ob qho tib si los ntawm European Association rau Palliative Care thiab EuropeanSociety rau Kev Kho Mob Oncology, tias cov tshuaj laxatives rau kev tswj hwm lossis kev tiv thaiv ntawm opioid-vim cem quav yuav tsum tau sau tseg [2, 13]. Kev siv tshuaj tua kab mob yuav tsum ua kom ncav cuag tsawg kawg peb lub plab zom mov hauv ib lub lis piam thiab tswj kev siv cov tsos mob ntawm tus kheej [7].

Lwm txoj kev ntawm kev tiv thaiv tej zaum yuav yog kev siv cov tshuaj opioid antagonists xws li ntev-tso naloxone ua ke nrog oxycodone [14].Cov pov thawj tsis zoo qhia tau hais tias naloxonein ua ke nrog oxycodone txo qhov kev pheej hmoo ntawm cem quav yam tsis muaj qhov mob ntxiv thaum piv nrog oxycodone ib leeg rau cov neeg laus. nrog rau mob qog noj ntshav thiab cem quav mob opioid [15]

Tag nrho cov tshuaj opioids ua rau cem quav, txawm tias sib txawv. Cov koob tshuaj ntau ntawm tramadol yog qhov qis qis dua li cov koob tshuaj me me ntawm morphine [16,17]. Qhov zaus ntawm cem quav tom qab oxycodoneor morphine zoo ib yam [18]. Parenteral opioids impair plab hnyuv peristalsis tsawg dua qhov ncauj [19] .Transdermal fentanyl thiab buprenorphine inducebowel tsis ua haujlwm tsawg dua, txawm hais tias lawv feem ntau tsis zoo tshwm sim [20–22].

Txawm li cas los xij, cov kev tshawb fawb loj hauv kev soj ntsuam, transdermal opioids tsis txawv ntawm qhov ncauj opioids nyob rau hauv cov zaus ntawm cem quav [23, 24].Bowel dysfunction tshwm sim los ntawm ob qho tib si hauv nruab nrab thiab peripheral kev txiav txim ntawm opioids.Lub hauv paus txheej txheem muaj xws li kev ua kom cov neurons nyob rau hauv tus txha caj qaum, ua rau lub plab zom mov qeeb thiab txo qis qis.

Txawm li cas los xij, OIC feem ntau yog tshwm sim los ntawm kev ua kom lub zos μ-opioid receptors nyob rau hauv lub plab, uas muaj nyob rau hauv lub plab, plab hnyuv, thiab txoj hnyuv, feem ntau nyob rau hauv myenteric thiab submucosal plexus, thiab nyob rau hauv lub immunecells ntawm lamina propria [25]. Kev cuam tshuam ntawm opioids thaum kawg suav txog peb lub plab zom mov: txo qis hauv cov kua dej, kev nyuaj siab ntawm peristaltic contractions thiab kev txhawb nqa ntawm cov qauv tsis muaj zog, thiab kev ua pa ntawm txhua tus sphincters [26]. Lub cev qhuav dej ntawm txoj hnyuv ua rau muaj qhov tshwm sim ntawm fecalstones, uas nyuaj rau defecate los ntawm lub qhov quav sphincter. Lub plab yog overloaded thiab txuas ntxiv los ntawm cov quav tawv no [25, 26].

Qhov no piav qhia vim li cas cov tshuaj laxative ntau tsis muaj txiaj ntsig [13] Ntawm qhov tod tes, osmotic thiab stimulant laxatives raug pom zoo hauv OIC. Txawm li cas los xij, lawv cov txiaj ntsig tsis zoo vim tias lawv tsis hais txog theopioid receptor-mediated mechanism ntawm lub plab zom mov, yog li cov neeg mob ntau yam tsis ua tiav cov tsos mob txaus txaus [27].Thiab qhov no, kev siv tshuaj laxative ntev tuaj yeem cuam tshuam nrog kev puas tsuaj rau lub cev. cov leeg nqaij ua haujlwm ntawm lub plab; khoom noj khoom haus tsis txaus nyob rau hauv cov nqe lus ntawm poob dej, vitamins, thiab minerals; thiab lub raum stonesor raum tsis ua haujlwm, ntxiv rau kev hloov kho cov teebmeem ntawm lwm cov tshuaj [28].

Yog li, lwm txoj hauv kev los yog lwm txoj hauv kev tuaj yeem ntxiv prokinetics, uas yuav ua rau kom muaj txiaj ntsig ntawm cov tshuaj laxatives lossis opioid antagonists. Txawm li cas los xij, cov ntaub ntawv pov thawj kho mob rau cov nyhuv no tsis tshua muaj, tshwj tsis yog rau 5-HT4 receptor agonistprucalopride [29]. Metoclopramide tsis ua rau lub plab, thiab yog li yuav tsum tsis txhob suav hais tias cem quav.

Nws muaj ib qho stimulatory kev txiav txim ntawm colonic peristalsis, propellingcolonic luminal ntsiab lus, txawv ntawm cov cisapride thiab mosapride, thiab yog li ntawd nws tej zaum yuav ib tug pab tau tshuaj rau kev kho mob ntawm functionalconstipation [30]. Polish cov txheej txheem qhia siv prokinetics, xws li itopride, rau kev kho mob cem quav [14]. Yog li ntawd, qee tus kws kho mob tshwj xeeb siv nws tawm ntawm daim ntawv lo, tsis yog rau dyspepsibut xwb rau kev tswj cem quav.Txoj kev tshawb no tsom xyuas seb itopride puas muaj txiaj ntsig hauv kev tswj hwm opioid-vim cem quav hauv cov neeg laus palliative care cov neeg mob hauv qhov chaw kho mob.

Cov txiaj ntsig tseem ceeb yog:

• Qhov kev hloov pauv ntawm qhov tsim nyog ntawm laxativeuse ntawm 0-4 ntsuas tom qab 7 hnub ntawmkev kho mob; tus lej tsis zoo txhais tau tias txo qis,

• Qhov nruab nrab ntawm cov plab hnyuv siab raum,

• the frequency [%] of constipation, defined as at least one of the following: – the last defecation > 2 days, – the number of days with defecation < 4, – any subjective bowel symptom with intensity >2 hauv qhov ntsuas 0–4 (raws li hauv qab no hauv p. 4 c–h).

Cov txiaj ntsig thib ob yog:

• zaus (%) ntawm cov neeg mob plab hnyuv tsuas yog tom qab enema (los yog phau ntawv stoolevacuation) tom qab 7 hnub ntawm kev kho mob,

• cuam tshuam.

Khoom siv thiab cov txheej txheem

Txoj kev tshawb nrhiav qhib no tau ua rau cov neeg laus palliative care cov neeg mob cem quav, uas tau txais cov tshuaj opioids thiab tsis tau kho nrog itopride ua ntej kev soj ntsuam. Txhua tus neeg mob tau txais cov tshuaj laxative tsis tu ncua, thiab ntxiv rau oxycodone / naloxone (OXN pawg), oritopride (ITP pawg), lossis oxycodone / naloxone + itopride (OXN + ITP pawg).

Pawg tswj hwm (CTRL) tsuas yog siv cov tshuaj laxatives xwb, yog tias tsim nyog.Cov txheej txheem suav nrog yog: daim ntawv pov thawj thiab ua tiav, hnub nyoog Ntau dua lossis sib npaug li 18 xyoo, tsev kho mob lossis tsev kho mob hauv tsev kho mob lossis chaw kho mob palliative kho mob sab nraud, yam tsawg kawg yog ob zaug mus ntsib hauv 7–8. nruab hnub (hnub 0 thiab hnub 7), muaj zog opioids siv 7 hnub ua ntej hnub 0 txog hnub 7, tsis muaj itopride siv txog hnub 0.

Cov qauv lus nug

Cov kws kho mob palliative tau siv daim ntawv nug los qhia cov ntaub ntawv khaws tseg hauv lawv cov ntaub ntawv kho mob. Daim ntawv nug suav nrog cov hauv qab no:

1) Hnub tim.

2) Qhov chaw (tsev, tsheb thauj neeg mob, tsev kho mob palliativecare ward, nyob rau hauv-neeg mob hospice).

3) ECOG kev ua tau zoo, ntsuas los ntawm tus kws kho mob.

4) Cov tsos mob ntawm plab hnyuv hauv 7 hnub dhau los, soj ntsuam los ntawm tus neeg mob:

a) qhov kawg defecation [hnub],

b) tus naj npawb ntawm cov hnub nrog lub plab zom mov [hnub],

c) qhov nyuaj ntawm kev tshem tawm ntawm qhov ntsuas {{0}}-4, qhov twg 0 - tsis muaj teeb meem ("feem ntau tsis zoo"), 1 - me me ("zoo li qub"), 2 - nruab nrab, 3 - tseem ceeb /feem ntau, 4 - nyuaj heev / ib txwm,

d) cov quav tsawg dhau ntawm {{0}}-4 nplai, qhov twg 0 - cov quav ib txwm, 1 - los ntawm ib ntus (mob hnyav), 2 - ntau zaus (nruab nrab siv), 3 - feem ntau , 4 - ib txwm,

e) cov quav hnyav dhau ntawm 0–4 nplai (saib saum toj),

f) qhov kev xav ntawm lub plab zom mov tsis tiav ntawm qhov ntsuas {{0}}-4, qhov twg 0 - tsis muaj tsos mob, 1 - mob me me / qee zaum, 2 - mob hnyav / nquag nquag, 3 - qhov hnyav hnyav / ntau zaus , 4 - kev siv zog heev / ib txwm,

g) straining los yog squeezing kom dhau lub plab zom mov, ntawm qhov ntsuas 0–4 (saib saum toj),

h) qhov tsim nyog ntawm kev siv cov tshuaj laxative ntawm ib qho {{0}}-4scale, qhov twg 0 - tsis muaj cov tshuaj laxatives, 1 - los ntawm lub sij hawm mus rau lub sij hawm (qee zaus), 2 - feem ntau siv, 3 - tso quav tso tom qab. Kev siv cov tshuaj laxative tsis tu ncua, 4 - tso quav tso zis tom qab enema lossis phau ntawv tshem tawm cov quav.

5) Cov koob tshuaj txhua hnub ntawm opioids, raug suav rov qab rau qhov sib npaug ntawm qhov ncauj morphine (Table I).

6) Itopride siv 50 mg tid (yog / tsis).

7) Cov teebmeem tsis zoo.

Txhua tus kws kho mob tau koom nrog hauv chav kawm tshwj xeeb ntawm kev tswj cov tsos mob ua ntej sau cov ntaub ntawv. Lawv tau paub txog Polish cov lus qhia txog kev tiv thaiv thiab kev kho mob cem quav hauv cov neeg mob palliative care. Lub hom phiaj ntawm kev kho mob laxative, raws li cov lus qhia no, yog ua kom lub plab zom mov hauv cov neeg mob noj tshuaj opioids tsawg kawg peb zaug hauv ib lub lis piam (zoo dua txhua hnub thib ob) [14].

Qhov chaw ntawm cov ntaub ntawv

Cov ntaub ntawv tau sau tseg hauv xyoo 2018 los ntawm 16 tus kws kho mob palliative hauv 10 (tsev, tus neeg mob hauv tsev, thiab kev thauj mus los) palliative care centers rau cov neeg laus.hauv tebchaws Poland. Txoj kev tshawb no tau txais kev pom zoo los ntawm pawg neeg ua haujlwm bioethical.Qhov loj ntawm pawg pawg yog ib qho ntawm cov txiaj ntsig thiab tsis yog yuav tsum tau kwv yees siv cov txheej txheem txheeb cais.Peb xav tias tsawg kawg ntawm 100 daim ntawv nug uas tau sau yuav tsum txaus siab los txheeb xyuas cov kev coj cwj pwm hais txog kev tiv thaiv cem quav.

Kev txheeb cais

Kruskal-Wallis thiab Mann-Whitney U kev xeem tau raug siv rau kev txheeb xyuas cov ntaub ntawv tsis yog parametric. Kev soj ntsuam zaus tau ua los ntawm kev siv c2 thiab Fisher qhov kev xeem kom raug. P-tus nqi tsawg dua 0.05 raug suav hais tias yog qhov tseem ceeb. Cov ntaub ntawv tau txheeb xyuas siv Statistica 13 (StatSoft).

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.