晚期癌症患者姑息性镇静治疗现状

《中国癌症杂志》2010年第20卷第9期 CHINA ONCOLOGY CHINA ONCOLOGY 2010 Vol.20 No.9

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晚期癌症患者姑息性镇静治疗现状

［摘要］　背景与目的：如何针对晚期癌症患者进行适当的镇静治疗，是姑息治疗领域的一个重要问题。本研究旨在探索接受姑息治疗的晚期癌症患者的镇静治疗现状，以期更好的指导临床。方法：回顾性分析2007年3月—2009年5月复旦大学附属肿瘤医院姑息治疗科收治的患者中119例死亡病例的完整资料。其中患者的生存期定义为入院时间至死亡时间，精确至天。应用Kaplan-Meier方法计算生存期，Log-rank检验差异性，t 检验及卡方检验比较接受及未接受镇静治疗患者的差异，logistic回归分析探索影响患者进行镇静治疗的因素。以P <0.05为检验标准。结果：119例患者中位生存时间为16 d。29例患者接受了姑息性镇静治疗，接受镇静与未接受镇静治疗的两组患者生存期差异无统计学意义。而谵妄（P <0.001）、呼吸困难（P =0.012）及睡眠倒错（P =0.003）为影响是否进行镇静治疗抉择的因素。结论：本研究首次揭示了基于中国晚期癌症人群的镇静治疗现状，证实了对于晚期癌症患者进行适当的镇静治疗的可行性，有益于姑息性镇静治疗的进一步开展。 ［关键词］　姑息治疗；　镇静治疗；　生存期

中图分类号：R730.59 文献标识码：A 文章编号：1007-3639(2010)09-0695-04

Palliative sedation for terminally ill cancer patients GU Xiao-li, CHENG Wen-wu (Department of

Palliative Care, Cancer Center, Fudan University, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China)

Correspondence to：CHENG Wen-wu　E-mail：cwwxmm@

［Abstract ］ Background and purpose ：The process of administering sedation among palliative patients is an important part of palliative care. This study assessed sedation in terminally cancer patients in terms of three characteristics: the actual survival and sedation, the characteristic difference between patients who received sedation or not and the factors that in fl uence the choice of sedation. Methods ：A retrospective analysis of the medical records of all 119 patients who were admitted and died at the Department of Palliative Care, Cancer Center, Fudan University between Mar. 2007 to May 2009 was performed. Data was collected, including demographic data, types of symptoms and types of sedation in the terminal phase. Results ：Twenty nine of 119 (24.4%) patients had received sedation. The median sedation duration was 30 hours. There was no signi fi cant difference in survival time between the sedated and non-sedated patients. Indications of sedation were delirium (P <0.001), shortness of breath (P =0.012) and severe insomnia (P =0.003). Conclusion ：Sedation, although an effective method for treating refractory symptoms of terminally ill cancer patients, was still in its early stages of development in China. Further study is needed to fi nd the most appropriate time of intervention and to improve the management of refractory symptom in terminal stage cancer patients.

　［Key words ］　palliative care; palliative sedation; survival

通讯作者：成文武　E-mail:cwwxmm@

晚期癌症患者的姑息治疗给患者提供最佳支持治疗以达到症状控制，从而改善患者生存质量的目的。有效的症状控制部分的减缓了患者的疼痛、恶心及呼吸困难等常见症状［1］。然而，多种症状相加的复杂性以及药物使用的相互矛盾，往往导致症状控制措施的失败。此时，姑息性镇静成为治疗难治性症状相关性痛

苦的一个重要手段［2］。姑息性镇静指为了治疗难治性症状，有目的地诱导和维持患者处于镇静状态。镇静药物的如何适当使用一直存在争议，镇静药物的使用是否会缩短晚期癌症患者的生存期，由于其牵涉到了伦理学问题而变得异常敏感［3］。而加倍剂量的镇静药物，其是否给患者带来临床受益也仍存在争议。如何适当而正确的针对晚期癌症患者进行镇静性治疗，