Nauck Friedemann, Ostgathe Christoph, Klaschik Eberhard, Bausewein Claudia, Fuchs Martin, Lindena Gabriele, Neuwöhner Karl, Schulenberg Dieter, Radbruch Lukas
Department of Anaesthesiology and Palliative Medicine, Malteser Hospital, University Bonn, Bonn, Germany.
Palliat Med. 2004 Mar;18(2):100-7. doi: 10.1191/0269216304pm852oa.
The development of palliative medicine in inpatient units in Germany has been impressive in the last years. As a first step of quality assurance, a core documentation form was developed in 1996. In 2001, 55 of the 83 palliative inpatient units in Germany and one unit each in Switzerland and Austria participated in the third phase of the evaluation of the core documentation. A total of 1304 patients were documented consecutively in the 57 units for a period of up to three months. This study investigates the frequency of drugs used in palliative care units in Germany. During inpatient treatment, the most common drug classes were strong opioids (68% of the patients), nonopioids (59%), corticosteroids (32%), laxatives (31%), antiemetics (27%), gastric protection agents (24%), neuroleptics (19%), sedatives/anxiolytics (18%), antidepressants (16%) and diuretics (15%). These ten drug classes made up for 72% of all prescriptions in the palliative care units. The substances used most frequently were dipyrone (47% of the patients), morphine (42%), fentanyl (28%), dexamethasone (27%), metoclopramide (21%), sodium picosulfate (15%), haloperidol (13%), pantoprazole (11%), macrogol (11%), amtriptyline (11%), furosemide (10%), omeprazole (9%), lactulose (8%), rofecoxib (8%) and lorazepam (7%). The 15 most commonly used drugs accounted for 54% of the prescriptions in the palliative care units in Germany. Drug treatment was related to sex, age and functional status of the patients. Patients who died in a palliative care unit had received significantly more frequent doses of neuroleptics (P < 0.001), corticosteroids (P < 0.001), sedatives/anxiolytics (P < 0.001) and strong opioids (P < 0.001). This study is the first representative and systematic evaluation of drug treatment in palliative care units in a European country. Many of the 'top 15' drugs were drugs included in the list of essential drugs of the World Health Organisation though availability and cultural differences have an effect on the use of drugs, e.g., the high usage of dipyrone in Germany. Age and sex-related differences in drug therapy were seen, and more research is needed to recognize possible undertreatment of symptoms in subgroups of patients, e.g., treatment of depression in older or male patients.
在过去几年中，德国住院病房姑息医学的发展令人瞩目。作为质量保证的第一步，1996年制定了一份核心文件表格。2001年，德国83个姑息治疗住院病房中的55个以及瑞士和奥地利各一个病房参与了核心文件评估的第三阶段。在这57个病房中，总共连续记录了1304名患者长达三个月的情况。本研究调查了德国姑息治疗病房中使用药物的频率。在住院治疗期间，最常用的药物类别是强效阿片类药物（68%的患者使用）、非阿片类药物（59%）、皮质类固醇（32%）、泻药（31%）、止吐药（27%）、胃保护剂（24%）、抗精神病药（19%）、镇静剂/抗焦虑药（18%）、抗抑郁药（16%）和利尿剂（15%）。这十种药物类别占姑息治疗病房所有处方的72%。最常使用的药物是安乃近（47%的患者使用）、吗啡（42%）、芬太尼（28%）、地塞米松（27%）、甲氧氯普胺（21%）、比沙可啶（15%）、氟哌啶醇（13%）、泮托拉唑（11%）、聚乙二醇（11%）、阿米替林（11%）、呋塞米（10%）、奥美拉唑（9%）、乳果糖（8%）、罗非昔布（8%）和劳拉西泮（7%）。这15种最常用的药物占德国姑息治疗病房处方的54%。药物治疗与患者的性别、年龄和功能状态有关。在姑息治疗病房死亡的患者接受抗精神病药（P<0.001）、皮质类固醇（P<0.001）、镇静剂/抗焦虑药（P<0.001）和强效阿片类药物（P<0.001）的剂量明显更频繁。本研究是对一个欧洲国家姑息治疗病房药物治疗的首次代表性和系统性评估。许多“最常用的15种”药物都在世界卫生组织基本药物清单中，尽管药物的可获得性和文化差异会影响药物的使用，例如德国安乃近使用率较高。观察到了药物治疗中与年龄和性别相关的差异，需要更多研究来识别患者亚组中可能存在的症状治疗不足情况，例如老年或男性患者的抑郁症治疗。
