Førde Reidun, Kongsgaard Ulf, Aasland Olaf Gjerløw
Legeforeningens forskningsinstitutt, Postboks 1152 Sentrum, 0107 Oslo.
Tidsskr Nor Laegeforen. 2006 Feb 9;126(4):471-4.
Guidelines for palliative sedation to dying patients were issued by the Council for Medical Ethics of the Norwegian Medical Association in 2001. This study is a follow up of these guidelines.
In 2002 an anonymous questionnaire was sent to 400 hospital departments. After two years, only 12 questionnaires had been returned. In addition to this survey we present data from a survey among a random sample of 1539 doctors.
Ten of the 12 treatments which were registered in detail concerned patients with advanced cancer and in great discomfort. Average age was 49. Pain, nausea, convulsions and dyspnoea were the most common symptoms. Nine out of the 12 patients were in pain. In no case the sedation was assessed to have been avoidable with more health care resources. Relatively few patients had been examined psychologically. The decisions were taken by several caregivers, always in accordance with the family's wish. Six of the patients whose conscience level was raised were sedated again. Midazolam and morphine were the two mostly-used drugs; doses used varied considerably. 12% of the surveyed physicians said that one or more dying patients had been given palliative sedation in their department during the last 12 months.
Palliative sedation for dying patients is probably used infrequently in Norway, and not to hasten death. In the cases which we have registered, palliative sedation was given to patients in great discomfort.
挪威医学协会医学伦理委员会于2001年发布了针对临终患者的姑息性镇静指南。本研究是对这些指南的后续跟进。
2002年向400个医院科室发送了一份匿名调查问卷。两年后，仅收到12份问卷回复。除了这项调查，我们还展示了对1539名医生随机抽样调查的数据。
详细记录的12例治疗中，有10例涉及晚期癌症且极度不适的患者。平均年龄为49岁。疼痛、恶心、抽搐和呼吸困难是最常见的症状。12例患者中有9例疼痛。在任何情况下，都认为增加医疗资源无法避免镇静。接受心理检查的患者相对较少。决策由多名护理人员做出，且始终符合家属的意愿。6名意识水平提高的患者再次接受了镇静。咪达唑仑和吗啡是最常用的两种药物；使用剂量差异很大。12%的受访医生表示，在过去12个月里，他们所在科室有一名或多名临终患者接受了姑息性镇静。
在挪威，临终患者的姑息性镇静可能使用频率不高，且并非为了加速死亡。在我们记录的案例中，姑息性镇静是给予极度不适的患者。
