Rosland Jan Henrik, Saunes Therese K, Bull Asta Nesse
Sunniva klinikk for lindrende behandling, Haraldsplass Diakonale Sykehus, Postboks 6165, 5892 Bergen.
Tidsskr Nor Laegeforen. 2007 Oct 18;127(20):2661-4.
Sedation of terminally ill patients is a debated issue. The prescription of sedative drugs to dying patients in a Norwegian unit for palliative care has been studied.
Journals from 47 patients, who died in Sunniva Hospice in Bergen during 2003, were examined retrospectively. All opioid analgesics and sedatives given to the patients during the last two days of life were recorded, as well as additional supportive treatment. The degree of consciousness was evaluated and classified in three levels.
All patients were given opioids, and 34 were given sedatives in addition. Midazolam was the most frequently prescribed drug. Seven patients received midazolam in doses that were considered as potentially sedative (> 20 mg/day). All seven had advanced cancer and five of them had metastases to lungs, bone or both. The most common reasons to give high doses of sedatives were intolerable pain and dyspnoea, often combined with an increase in tolerance. One patient required acute sedation. Even though reduced consciousness was observed in some patients, none met the criteria for palliative sedation of dying patients.
Drugs that may reduce consciousness are often prescribed to dying patients. As long as the aim is to reduce specific symptoms, this is a natural part of palliative treatment. Documentation with specification for the aim of the treatment is mandatory. This is especially important when consciousness is reduced.
对晚期患者进行镇静是一个存在争议的问题。挪威一家姑息治疗病房针对临终患者使用镇静药物的情况展开了研究。
对2003年在卑尔根的桑尼瓦临终关怀院去世的47例患者的病历进行回顾性研究。记录患者在生命最后两天所使用的所有阿片类镇痛药和镇静剂，以及其他支持性治疗。对意识程度进行评估并分为三个等级。
所有患者均使用了阿片类药物，另外34例患者还使用了镇静剂。咪达唑仑是最常开具的药物。7例患者接受了被认为可能具有镇静作用的剂量（>20毫克/天）的咪达唑仑。这7例患者均患有晚期癌症，其中5例发生了肺、骨或两者的转移。给予高剂量镇静剂的最常见原因是难以忍受的疼痛和呼吸困难，且常伴有耐受性增加。1例患者需要进行紧急镇静。尽管在部分患者中观察到意识减退，但无患者符合临终患者姑息性镇静的标准。
可能降低意识的药物经常被开给临终患者。只要目的是减轻特定症状，这就是姑息治疗的自然组成部分。必须记录治疗目的的具体说明。当意识减退时，这一点尤为重要。
