| Abstract | Uvod. Kod palijativnih bolesnika bol predstavlja vodeći simptom te je kontrola boli jedan od
najbitnijih zadaća kvalitetne palijativne skrbi. Opioidi i dalje predstavljaju zlatni standard u
kupiranju boli kod palijativnih bolesnika, a subkutani način primjene pokazao se kao siguran,
fleksibilan i praktičan. S progresijom bolesti vrlo često dolazi do intenziviranja boli koja se sve
teže kupira. Obzirom na ograničenja koja su prisutna kod peroralnog i transdermalnog načina
primjene opioida alternativa je primjena putem subkutane morfinske pumpe.
Cilj. Cilj istraživanja je dokazati da se primjenom morfina putem morfinske pumpe postiže
značajno bolja kontrola boli i bolja kvaliteta života kod palijativnih bolesnika.
Metode. Istraživanje je provedeno u Ambulanti za liječenje boli i Ambulanti za palijativnu
medicinu Zavoda za anesteziologiju, intenzivnu medicinu i liječenja boli, KBC Sestre
milosrdnice. Prikupljanje podataka je proveo istraživač osobno, kroz 6 mj. Za procjenu boli i
prisutnih simptoma korišteni su validirani upitnici NRS skala i ESAS upitnik, a za procjenu
kvalitete života EORTC QLO-C30 upitnik, uz suglasnost autora upitnika. Analizirani su NRS
skala, ESAS upitnik i EORTC QLO-C30 upitnik u tri navrata, prije primjene morfinske pumpe,
nakon tjedan dana te nakon tri tjedna primjene. Putem NRS skale mjerio se intenzitet boli u
sva tri intervala, dok je ESAS upitnik i EORTC QLO-C30 upitnik analiziran prije primjene i
nakon tri tjedna.
Rezultati. Iz minimalnog i maksimalnog postignutog rezultata može se vidjeti da nakon
primjene morfinske pumpe, u 1. i 2. mjerenju, niti jedan bolesnik ne navodi NRS vrijednost
veću od 5, dok su inicijalne vrijednosti išle do NRS 10. ESAS upitnikom utvrđeno je u zadnjem
mjerenju, što je nakon tri tjedana od početnog, da više niti jedan bolesnik ne navodi
maksimalnu vrijednost simptoma i poteškoća. Upitnikom EORTC QLQ-C30 ispitanim nakon
subkutane primjene opioida dobivaju se rezultati u 2. mjerenju do maksimalne vrijednosti 6
(od mogućih 7, pri čemu viši rezultati ukazuju na bolje stanje i kvalitetu života).
Zaključak. Provedenim istraživanjem palijativni bolesnici, kojima je propisana terapija
morfinskom pumpom, imaju bolju kontrolu boli u odnosu na ranije te time bolju kvalitetu
života. Individualnim pristupom palijativnim bolesnicima kao i adekvatnom titracijom
opioida, subkutanim putem, dolazi do smanjivanja popratnih simptoma osnovne bolesti,
povećava se sposobnost svakodnevnog funkcioniranja te u konačnici dolazi do poboljšanja
opće kvalitete života. |
| Abstract (english) | Background. In palliative patients, pain is the leading symptom, and pain control is one of
the most important tasks of high-quality palliative care. Opioids remain the gold standard for
pain relief in palliative patients, and the subcutaneous method of application has been shown
to be safe, flexible, and practical. As the disease progresses, there is often an intensification of
pain that becomes increasingly difficult to control. Given the limitations of oral and
transdermal application of opioids, via a subcutaneous morphine pump is an alternative.
Aim. The aim of this research is to demonstrate that the use of morphine via a morphine pump
in palliative patients results in significantly better pain control and a higher quality of life
Methods. The study will be conducted on the premises of the Pain Management Outpatient
Clinic and the Palliative Care Outpatient Clinic of the Department of Anesthesiology, Critical
Care and Pain Management at KBC Sisters of Mercy. Data collection will be conducted by the
researcher in person over a 6-month period. The validated questionnaires NRS and ESAS will
be used to assess pain, and the questionnaire EORTC QLO-C30 will be used to assess quality
of life, with the consent of the author of the questionnaire. Data will be analyzed on three
occasions, before the use of the morphine pump, after one week and after three weeks of use,
measuring pain intensity using the NRS scale, while the ESAS questionnaire and the EORTC
QLO -C30 questionnaire will be analyzed before and after three weeks.
The results. From the minimum and maximum results achieved, it can be seen that after the
application of the morphine pump, in the 1st and 2nd measurements, not a single patient
stated a NRS value higher than 5, while the initial values went up to NRS 10. The ESAS
questionnaire determined in the last measure, which is after three weeks from the beginning,
that not a single patient mentions the maximum value of symptoms and difficulties. The
EORTC QLQ-C30 questionnaire tested after subcutaneous administration of opioids gives
results in the 2nd measurement up to a maximum value of 6 (out of a possible 7, with higher
scores indicating a better condition and quality of life).
Conclusion. According to the conducted research, palliative patients who are prescribed
morphine pump therapy have better pain control compared to before and a better quality of
life. An individual approach to palliative patients, as well as adequate titration of opioids,
subcutaneously, reduces accompanying symptoms of the underlying disease, increases the
ability to function on a daily basis, and ultimately improves the general quality of life. |
