Dalal Shalini, Del Fabbro Egidio, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, 77030, USA.
J Palliat Med. 2006 Apr;9(2):391-408. doi: 10.1089/jpm.2006.9.391.
Achieving the best quality of life for patients and their families when a disease becomes progressive and no longer remains responsive to curative therapy is the primary goal of palliative care. A comprehensive care plan focusing on control of physical symptoms as well as psychological, social, and spiritual issues then becomes paramount in that context. Symptom assessment and treatment are a principle part of palliative care. This paper is the first of three in a series addressing non-pain symptoms, which are frequently encountered in the palliative care populations. The most frequent non-pain symptoms are constipation, chronic nausea and vomiting, anorexia, dyspnea, fatigue, and delirium. As symptoms are subjective, their expression varies from patient to patient, depending on the individual patient's perception and on other factors such as psychosocial issues. While symptoms are addressed individually, patients frequently have multiple coexisting symptoms. Generally told, once the intensity of a symptom has been assessed, it is necessary to assess the symptom in the context of other symptoms such as pain, appetite, fatigue, depression, and anxiety. Given that fact, adopting a multidimensional assessment allows for formulation of a more effective therapeutic strategy. More pertinently, this paper highlights the management of non-pain symptoms as an integral part of patient care and reviews the pathophysiologies, causes, assessment, and management of constipation, chronic nausea, and vomiting, each of which is common among the palliative care population.
当疾病进展且不再对治愈性治疗有反应时，为患者及其家属实现最佳生活质量是姑息治疗的首要目标。在这种情况下，制定一个侧重于控制身体症状以及心理、社会和精神问题的综合护理计划就变得至关重要。症状评估和治疗是姑息治疗的主要组成部分。本文是关于姑息治疗人群中经常遇到的非疼痛症状的系列文章中的第一篇。最常见的非疼痛症状是便秘、慢性恶心和呕吐、厌食、呼吸困难、疲劳和谵妄。由于症状是主观的，其表现因患者而异，这取决于个体患者的感知以及其他因素，如心理社会问题。虽然症状是分别处理的，但患者经常同时存在多种症状。一般来说，一旦评估了一种症状的强度，就有必要在其他症状（如疼痛、食欲、疲劳、抑郁和焦虑）的背景下评估该症状。鉴于这一事实，采用多维评估有助于制定更有效的治疗策略。更确切地说，本文强调了非疼痛症状的管理是患者护理的一个组成部分，并综述了便秘、慢性恶心和呕吐的病理生理学、病因、评估和管理，这些在姑息治疗人群中都很常见。
