癌症患者的咳嗽干预
2010/11/04
摘要
背景：咳嗽是癌症患者的常见症状，特别是在肺癌患者中。在临床实践中咳嗽常常没有得到很好的控制，临床医生对咳嗽的治疗方法也较少。
目的：本综述的主要目的是研究药物治疗和非药物性干预措施（除了化疗和外放射治疗）在治疗恶性肿瘤（特别是肺癌）患者咳嗽中的有效性。
检索策略：检索数据库包括：Cochrane对照试验中心注册（CENTRAL）和有效性回顾摘要数据库（DARE）（Cochrane图书馆第4期，2009）、MEDLINE（1966至2010年5月）、EMBASE（1980至2010年5月）、CINAHL（1980至2010年5月）、PSYCHINFO（1980至2010年5月）、AMED（1985至2010年5月）SIGLE（1980至2010年5月）、英国护理学索引（1985至2010年5月）、CancerLit（1975至 2010年5月）。我们对咳嗽抑制剂、止咳药及其他止咳活性药物和非药物性干预措施进行了检索（检索策略见附录1～4）。
选择标准：我们选择随机对照试验（RCTs）和临床试验（准试验、以及有比较组但无随机的试验），参与者患有原发性或转移性肺癌或其他恶性肿瘤。
数据收集及分析：两名综述作者对所有研究的题目和摘要进行了独立的评估，从研究中提取信息，并达成共识。第三名综述作者对存在的分歧做出判断。对异质性研究进行荟萃分析。
主要结果：17项研究满足纳入标准，研究了短程疗法或激光/光动力治疗（8项研究）及一些药物治疗方法（9项研究）。总体来说，缺少可信的证据，大部分试验的研究方法质量较低，存在较大偏倚。某些剂量的短程疗法在某些患者能改善患者的咳嗽，表明需要采用最小剂量以减少副作用。一项对光动力治疗的研究显示能改善咳嗽，但与其他研究相比，其对咳嗽的治疗作用尚未知。吗啡、可待因、双氢可待因、左羟丙哌嗪、色甘酸钠、布他米酯柠檬酸糖浆（咳嗽糖浆）治疗也观察到治疗咳嗽的有效性，但所有研究都存在显著的偏倚风险。
作者结论：本综述未得到明确的指导实践的推荐方案。有必要增加研究的质量和数量，以评价癌症患者咳嗽干预措施的疗效。
（林江涛 审校）
Cochrane Database Syst Rev. 2010 Sep 8;9:CD007881.
Interventions for cough in cancer.
Molassiotis A, Bailey C, Caress A, Brunton L, Smith J.
School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK, M13 9PL.
Abstract
BACKGROUND: Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it.
OBJECTIVES: The primary objective of this review was to determine the effectiveness of interventions, both pharmacological and non-pharmacological, (other than chemotherapy and external beam radiotherapy) in the management of cough in malignant disease (especially in lung cancer).
SEARCH STRATEGY: Databases searched included: The Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness (DARE) (The Cochrane Library issue 4, 2009); MEDLINE (1966 to May 2010); EMBASE (1980 to May 2010); CINAHL (1980 to May 2010); PSYCHINFO (1980 to May 2010); AMED (1985 to May 2010); SIGLE (1980 to May 2010); British Nursing Index (1985 to May 2010); CancerLit (1975 to May 2010). We searched for cough suppressants, antitussives and other drugs with antitussive activity as well as non-pharmacological interventions (see Appendices 1-4 for search terms).
SELECTION CRITERIA: We selected randomised controlled trials (RCTs) and clinical trials (quasi-experimental trials, and trials where there is a comparison group but no mention of randomisation) in participants with primary or metastatic lung cancer or other cancers.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of all studies, and extracted data from all selected studies before reaching consensus. A third review author arbitrated with any disagreement. Meta-analysis was not attempted due to the heterogeneity of studies.
MAIN RESULTS: Seventeen studies met inclusion criteria and examined either brachytherapy, laser or photodynamic therapy (eight studies) or a variety of pharmacological therapies (nine studies). Overall, there was absence of credible evidence and the majority of studies were of low methodological quality and high risk of bias. Brachytherapy seemed to improve cough in a variety of doses in selected participants, suggesting that possibly the lowest effective dose should be used to minimise side effects. Photodynamic therapy was examined in one study, and while improvements in cough were observed, its role over other therapies for cough is unclear. Some indication of effect was observed with morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (cough syrup), although all studies had significant risk of bias.
AUTHORS’ CONCLUSIONS: No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions in the management of cough in cancer.
Cochrane Database Syst Rev. 2010 Sep 8;9:CD007881.
背景：咳嗽是癌症患者的常见症状，特别是在肺癌患者中。在临床实践中咳嗽常常没有得到很好的控制，临床医生对咳嗽的治疗方法也较少。
目的：本综述的主要目的是研究药物治疗和非药物性干预措施（除了化疗和外放射治疗）在治疗恶性肿瘤（特别是肺癌）患者咳嗽中的有效性。
检索策略：检索数据库包括：Cochrane对照试验中心注册（CENTRAL）和有效性回顾摘要数据库（DARE）（Cochrane图书馆第4期，2009）、MEDLINE（1966至2010年5月）、EMBASE（1980至2010年5月）、CINAHL（1980至2010年5月）、PSYCHINFO（1980至2010年5月）、AMED（1985至2010年5月）SIGLE（1980至2010年5月）、英国护理学索引（1985至2010年5月）、CancerLit（1975至 2010年5月）。我们对咳嗽抑制剂、止咳药及其他止咳活性药物和非药物性干预措施进行了检索（检索策略见附录1～4）。
选择标准：我们选择随机对照试验（RCTs）和临床试验（准试验、以及有比较组但无随机的试验），参与者患有原发性或转移性肺癌或其他恶性肿瘤。
数据收集及分析：两名综述作者对所有研究的题目和摘要进行了独立的评估，从研究中提取信息，并达成共识。第三名综述作者对存在的分歧做出判断。对异质性研究进行荟萃分析。
主要结果：17项研究满足纳入标准，研究了短程疗法或激光/光动力治疗（8项研究）及一些药物治疗方法（9项研究）。总体来说，缺少可信的证据，大部分试验的研究方法质量较低，存在较大偏倚。某些剂量的短程疗法在某些患者能改善患者的咳嗽，表明需要采用最小剂量以减少副作用。一项对光动力治疗的研究显示能改善咳嗽，但与其他研究相比，其对咳嗽的治疗作用尚未知。吗啡、可待因、双氢可待因、左羟丙哌嗪、色甘酸钠、布他米酯柠檬酸糖浆（咳嗽糖浆）治疗也观察到治疗咳嗽的有效性，但所有研究都存在显著的偏倚风险。
作者结论：本综述未得到明确的指导实践的推荐方案。有必要增加研究的质量和数量，以评价癌症患者咳嗽干预措施的疗效。
（林江涛 审校）
Cochrane Database Syst Rev. 2010 Sep 8;9:CD007881.
Interventions for cough in cancer.
Molassiotis A, Bailey C, Caress A, Brunton L, Smith J.
School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK, M13 9PL.
Abstract
BACKGROUND: Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it.
OBJECTIVES: The primary objective of this review was to determine the effectiveness of interventions, both pharmacological and non-pharmacological, (other than chemotherapy and external beam radiotherapy) in the management of cough in malignant disease (especially in lung cancer).
SEARCH STRATEGY: Databases searched included: The Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness (DARE) (The Cochrane Library issue 4, 2009); MEDLINE (1966 to May 2010); EMBASE (1980 to May 2010); CINAHL (1980 to May 2010); PSYCHINFO (1980 to May 2010); AMED (1985 to May 2010); SIGLE (1980 to May 2010); British Nursing Index (1985 to May 2010); CancerLit (1975 to May 2010). We searched for cough suppressants, antitussives and other drugs with antitussive activity as well as non-pharmacological interventions (see Appendices 1-4 for search terms).
SELECTION CRITERIA: We selected randomised controlled trials (RCTs) and clinical trials (quasi-experimental trials, and trials where there is a comparison group but no mention of randomisation) in participants with primary or metastatic lung cancer or other cancers.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of all studies, and extracted data from all selected studies before reaching consensus. A third review author arbitrated with any disagreement. Meta-analysis was not attempted due to the heterogeneity of studies.
MAIN RESULTS: Seventeen studies met inclusion criteria and examined either brachytherapy, laser or photodynamic therapy (eight studies) or a variety of pharmacological therapies (nine studies). Overall, there was absence of credible evidence and the majority of studies were of low methodological quality and high risk of bias. Brachytherapy seemed to improve cough in a variety of doses in selected participants, suggesting that possibly the lowest effective dose should be used to minimise side effects. Photodynamic therapy was examined in one study, and while improvements in cough were observed, its role over other therapies for cough is unclear. Some indication of effect was observed with morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (cough syrup), although all studies had significant risk of bias.
AUTHORS’ CONCLUSIONS: No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions in the management of cough in cancer.
Cochrane Database Syst Rev. 2010 Sep 8;9:CD007881.
上一篇：
青少年或成人咳嗽患者中是否存在百日咳？
下一篇：
在不吸烟的健康人群中用柠檬酸诱导的咳嗽冲动感以及呼吸困难的性别差异
