Vissers Kris C P, Hasselaar Jeroen, Verhagen Stans A H H V M
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, The Netherlands.
Curr Opin Anaesthesiol. 2007 Apr;20(2):137-42. doi: 10.1097/ACO.0b013e328049557b.
Palliative sedation, the conscious induction of sleep in patients with a very short life expectancy who suffer intractable physical and existential distress, may offer the patient and his or her relatives a more peaceful dying. This technique is still subject to several ethical and medical controversies justifying a review of the recent literature on this subject.
The available evidence consists of few prospective trials and mainly retrospectively collected case reports. Two guidelines are published in the period under review. The most important points stressed in these reviews are the careful information exchange with the patient, if possible, and his or her proxies, a gradually increased sedation allowing respite if possible to evaluate the effect of the sedation and the need for consultation with colleagues, preferentially physicians experienced in palliative care. Stopping artificial nutrition and hydration is a medical decision that should be taken after evaluation of the potential side effects and consultation with the patient and relatives.
Palliative sedation may be considered for terminally ill patients who suffer intractable symptoms. Ideally it should be included in the patient's trajectory that has been described and discussed earlier when the disease was judged to be incurable. The main goal is to offer comfort.
姑息性镇静是指在预期寿命极短、遭受难以忍受的身体和生存痛苦的患者中，有意识地诱导其睡眠，这可能会让患者及其亲属有一个更安宁的死亡过程。这项技术仍然存在一些伦理和医学争议，因此有必要对近期关于该主题的文献进行综述。
现有证据包括少量前瞻性试验以及主要是回顾性收集的病例报告。在本综述期间发表了两项指南。这些综述中强调的最重要的几点是：如果可能，要与患者及其代理人进行仔细的信息交流；逐渐增加镇静深度，如有可能让患者缓解一下，以便评估镇静效果以及是否需要与同事，最好是有姑息治疗经验的医生进行会诊。停止人工营养和水分补充是一项医疗决策，应在评估潜在副作用并与患者及亲属协商后做出。
对于患有难以忍受症状的晚期患者，可以考虑采用姑息性镇静。理想情况下，当疾病被判定为无法治愈时，应将其纳入之前已描述和讨论过的患者病程中。主要目标是提供舒适感。
