Morita Tatsuya, Hyodo Ichinosuke, Yoshimi Taisuke, Ikenaga Masayuki, Tamura Yoichiro, Yoshizawa Akitaka, Shimada Akira, Akechi Tatsuo, Miyashita Mitsunori, Adachi Isamu
Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
J Pain Symptom Manage. 2006 Feb;31(2):130-9. doi: 10.1016/j.jpainsymman.2005.06.015.
To explore the association between hydration volume and laboratory findings, and between calculated fluid balance and changes in clinical signs of dehydration and fluid retention in terminally ill cancer patients, a secondary analysis of a large multicenter, prospective, observational study was performed. The study enrolled 125 abdominal cancer patients who received laboratory examinations in the last week before death. Patients were classified into two groups: the hydration group (n = 44), who received 1L or more of artificial hydration per day both 1 and 3 weeks before death, and the nonhydration group (n = 81). The mean albumin level 1 week before death was significantly lower in the hydration group than in the nonhydration group, and the interaction between hydration group and decrease in the albumin level was statistically significant after adjusting multiple covariates (from 2.8 +/- 0.68 mg/dL 3 weeks before death to 2.4 +/- 0.56 mg/dL 24 hours before death in the hydration group vs. a decrease of 2.8 +/- 0.53 to 2.6+ /- 0.45 mg/dL in the nonhydration group, P = 0.015). There was no significant difference between the groups in the mean blood urea nitrogen/creatinine, sodium, or potassium levels 1 week before death. Among 53 patients who had oral fluid intake of less than 500 mL/day throughout the last 3 weeks and completed a fluid balance study, the median of calculated fluid balance was -400 mL/day 3 weeks before death, -521 mL/day 1 week before death, and -421 mL/day 24 hours before death. Calculated fluid balances did not significantly differ between the patients with deterioration of dehydration signs, edema, ascites, and pleural effusion during the final 3 weeks and those without. These data suggest that active artificial hydration might result in hypoalbuminemia, with no clear beneficial effects on normalizing blood urea nitrogen/creatinine, sodium, or potassium levels. Fluid balance did not significantly correlate with changes in dehydration-and fluid retention-signs. Calculated fluid balance is not an appropriate alternative to direct monitoring of patient symptoms. More studies are needed to determine the clinical efficacy of artificial hydration for terminally ill cancer patients.
为了探究补液量与实验室检查结果之间的关联，以及计算得出的液体平衡与晚期癌症患者脱水和液体潴留临床体征变化之间的关联，我们对一项大型多中心前瞻性观察性研究进行了二次分析。该研究纳入了125例在死亡前最后一周接受实验室检查的腹部癌症患者。患者被分为两组：补液组（n = 44），在死亡前1周和3周每天接受1升或更多的人工补液；非补液组（n = 81）。死亡前1周，补液组的平均白蛋白水平显著低于非补液组，在调整多个协变量后，补液组与白蛋白水平下降之间的交互作用具有统计学意义（补液组从死亡前3周的2.8±0.68mg/dL降至死亡前24小时的2.4±0.56mg/dL，而非补液组从2.8±0.53降至2.6±0.45mg/dL，P = 0.015）。死亡前1周，两组的平均血尿素氮/肌酐、钠或钾水平无显著差异。在最后3周口服液体摄入量少于500mL/天且完成液体平衡研究的53例患者中，计算得出的液体平衡中位数在死亡前3周为-400mL/天，死亡前1周为-521mL/天，死亡前24小时为-421mL/天。在最后3周内出现脱水体征、水肿、腹水和胸腔积液恶化的患者与未出现这些情况的患者之间，计算得出的液体平衡无显著差异。这些数据表明，积极的人工补液可能导致低白蛋白血症，对使血尿素氮/肌酐、钠或钾水平正常化没有明显的有益影响。液体平衡与脱水和液体潴留体征的变化没有显著相关性。计算得出的液体平衡并非直接监测患者症状的合适替代方法。需要更多研究来确定人工补液对晚期癌症患者的临床疗效。
