Bruera E, Schmitz B, Pither J, Neumann C M, Hanson J
Department of Symptom Control and Palliative Care, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
J Pain Symptom Manage. 2000 May;19(5):357-62. doi: 10.1016/s0885-3924(00)00126-3.
Dyspnea is a devastating symptom in patients with advanced cancer. Unfortunately, very limited research has been done on the frequency and correlates of dyspnea in this particular patient population. The purpose of this prospective study was to assess the frequency of moderate to severe dyspnea and the correlates of dyspnea in a population of ambulatory terminally ill cancer patients. One hundred thirty-five consecutive patients attending a multidisciplinary pain clinic were tested for respiratory function (vital capacity, peak flow, maximal inspiratory pressure, and oxygen saturation). All patients gave their rating of dyspnea, anxiety, and fatigue/tiredness using visual analogue scales (VAS). Lung involvement by the tumor (primary or metastatic) was determined from the patient's chart. Moderate dyspnea occurred in 74/135 (55%) patients with terminal cancer. Lung involvement (r = 0.285, P = 0. 0009), anxiety (r = 0.306, P = 0.0003), fatigue/tiredness (r = 0.211, P = 0.0146), and vital capacity (r = -0.189, P = 0.0444) were significantly correlated with the intensity of dyspnea. Multivariate analysis demonstrated that lung involvement (P = 0.0016) and anxiety (P = 0.0027) were independently correlated with the intensity of dyspnea. In the subgroup of patients with moderate to severe dyspnea, multivariate analysis found anxiety (P = 0.0318) and maximal inspiratory pressure (P = 0.0187) to be independent correlates of the intensity of dyspnea. Dyspnea is a frequent symptom in patients with advanced cancer. The presence of cancer in the lungs, anxiety, and maximal inspiratory pressure are correlates of the intensity of dyspnea in this patient population. Possible treatments addressing low maximal inspiratory pressure and anxiety are needed, as well as further research in finding new correlates of dyspnea in advanced cancer patients.
呼吸困难是晚期癌症患者的一种严重症状。不幸的是，针对这一特定患者群体中呼吸困难的发生率及其相关因素的研究非常有限。这项前瞻性研究的目的是评估晚期癌症门诊患者中重度至极重度呼吸困难的发生率及其相关因素。对连续就诊于多学科疼痛门诊的135例患者进行了呼吸功能测试（肺活量、峰值流量、最大吸气压力和血氧饱和度）。所有患者使用视觉模拟量表（VAS）对呼吸困难、焦虑和疲劳/疲倦进行评分。根据患者病历确定肿瘤（原发性或转移性）对肺部的累及情况。74/135（55%）的晚期癌症患者出现中度呼吸困难。肺部受累（r = 0.285，P = 0.0009）、焦虑（r = 0.306，P = 0.0003）、疲劳/疲倦（r = 0.211，P = 0.0146）和肺活量（r = -0.189，P = 0.0444）与呼吸困难的强度显著相关。多变量分析表明，肺部受累（P = 0.0016）和焦虑（P = 0.0027）与呼吸困难的强度独立相关。在中度至重度呼吸困难患者亚组中，多变量分析发现焦虑（P = 0.0318）和最大吸气压力（P = 0.0187）是呼吸困难强度的独立相关因素。呼吸困难是晚期癌症患者的常见症状。肺部存在癌症、焦虑和最大吸气压力是该患者群体中呼吸困难强度的相关因素。需要针对低最大吸气压力和焦虑的可能治疗方法，以及进一步研究以发现晚期癌症患者呼吸困难的新相关因素。
