A Comparison of the Pain Experience After Subcutaneous Administration of Phosphate-Buffered and Citrate-Buffered Epoetin Alfa in Hemodialysis Patients

血液透析患者接受不同紅血球生成素注射的疼病經驗比較

林靜皓(Chin-Hao Lin) ； 馬紹銘(Shao-Ming Ma) ； 楊垂勳(Chwei-Shiun Yang)

《Acta Nephrologica》 14卷3期 (2000/07) Pp. 113-116

摘要

皮下注射紅血球生成素已知較靜脈注射有更佳的療效，但皮下注射會引起病患抱怨注射部位的疼痛不適。為了減輕病患的疼痛不適，我們進行了一個雙盲隨機交叉試驗的研究。我們評估40位血液透析患者分別接受以檸檬酸鹽（製劑A）與磷酸鹽（製劑B）為緩衝溶液的紅血球生成素製劑皮下注射後的疲痛差異情形。每個患者皆在2週內接受各2次的製劑A與製劑B的皮下注射。本篇研究所使用的疼痛評估方法為視覺類此量法與語言描述量度法。由總數160次注射的反應結果顯示，以磷酸鹽為緩衝溶液的紅血球生成素比較不會引起疼痛。在對疼痛的主觀感覺評估方面，46.25%的檸檬酸鹽紅血球生成素注射反應為感覺不痛或輕微疼痛，68.75%的磷酸鹽紅血球生成素注射反應為感覺不痛或輕微疼痛。對疼痛的主觀感覺並不因性別、糖尿病和接受透丁的時間而有差異。本篇研究顯示紅血球生成素的添加物可能是引起皮下注射疼痛的主因，以磷酸鹽為緩衝劑的紅血球生成素可減輕病患的疼痛不適並改善病患的順應性。

並列摘要

Subcutaneous (SC) injection of recombinant human erythropoietin (rHuEPO) is considered to be more effective than intravenous (IV) form. A major complaint with SC rHuEPO is pain at the injection site. We performed a double-blind crossover study to evaluate the local pain due to SC EPO. Experience of pain after subcutaneous injection of citrate-buffered epoetin alfa solution (preparation A) and phosphate-buffered epoetin alfa solution (preparation B) were assessed in forty hemodialysis patients. The patients rated the pain using a visual analogue scale (VAS) and a verbal descriptive scale (VDS) following each two subcutaneous injections of preparation A and preparation B over a two-week period. Results by VAS and VDS based upon 160 responses showed that phosphate-buffered epoetin alfa was significantly more painless than citrate-buffered epoetin alfa (P＜0.001). The results showed that after administration of phosphate-buffered epoetin alfo, the large majority (55 responses: 68.75%) reported no or very mild pain after SC administration. The subjective response to pain was not different in genders, diabetes, or time on hemodialysis. The results suggest that the local pain after subcutaneous injection may be related to the additives in the EPO preparations. The phosphate-buffered epoetin alfa may minimize patient discomfort and improve patient compliance.

並列關鍵字

erythropoietin ； hemodialysis ； local pain ； subcutaneous adminstration