阿片类药物治疗慢性阻塞性肺疾病伴难治性呼吸困难的研究进展

摘要

阿片类药物治疗呼吸困难的可能作用机制为阻断脑干网状上行激动系统的α受体、降低中枢和外周神经系统（主要是颈动脉体）对缺氧和高碳酸血症的敏感性、改变呼吸困难的中枢感知等，通过口服、注射阿片类药物能明显缓解慢性阻塞性肺疾病（COPD）患者的难治性呼吸困难，但目前尚无统一的给药标准。临床研究显示，用于治疗呼吸困难的阿片类药物剂量尚不能引起临床可观测到的呼吸抑制，因此对有难治性呼吸困难的 COPD 患者可以考虑使用阿片类药物治疗。本文主要从呼吸困难的主要发生机制、阿片类药物治疗呼吸困难的可能机制、阿片类药物治疗COPD 伴难治性呼吸困难的临床应用及使用阿片类药物治疗呼吸困难可能存在的不良反应等方面进行综述。%The possible mechanism of opioids in treating dyspnea includes interdicting the α receptors of brain stem reticular uplink excited system,reducing the sensitivity of central and peripheral nervous system(mainly was carotid body)to anoxia and hypercapnia,changing the central perception of dyspnea and so on,though opioids(oral administration or injection) can effectively relieve refractory dyspnea on clinic,but its using standard does not reach an agreement so far. In clinical practice, the common dosage of opioids in treating dyspnea can not lead to respiratory inhibition than can be observed,so opioids can be reasonably used in treating refractory dyspnea of patients with chronic obstructive pulmonary disease. This paper reviewed the pathogenesis of dyspnea,possible mechanism of opioids in treating dyspnea,clinical practice of opioids in treating dyspnea and related adverse reactions,to provide references for clinicians.