Booth Sara, Moosavi Shakeeb H, Higginson Irene J
Cambridge University NHS Foundation Trust Hospital, UK.
Nat Clin Pract Oncol. 2008 Feb;5(2):90-100. doi: 10.1038/ncponc1034.
Intractable breathlessness is a common, devastating symptom of advanced cancer causing distress and isolation for patients and families. In advanced cancer, breathlessness is complex and usually multifactorial and its severity unrelated to measurable pulmonary function or disease status. Therapeutic advances in the clinical management of dyspnea are limited and it remains difficult to treat successfully. There is growing interest in the palliation of breathlessness, and recent work has shown that a systematic, evidence-based approach by a committed multidisciplinary team can improve lives considerably. Where such care is lacking it may be owing to therapeutic nihilism in clinicians untrained in the management of chronic breathlessness and unaware that there are options other than endurance. Optimum management involves pharmacological treatment (principally opioids, occasionally oxygen and anxiolytics) and nonpharmacological interventions (including use of a fan, a tailor-made exercise program, and psychoeducational support for patient and family) with the use of parenteral opioids and sedation at the end of life when appropriate. Effective care centers on the patient's needs and goals. Priorities in breathlessness research include studies on: neuroimaging, the effectiveness of new interventions, the efficacy, safety, and dosing regimens of opioids, the contribution of deconditioning, and the effect of preventing or reversing breathlessness.
难治性呼吸困难是晚期癌症常见的、极具破坏性的症状，给患者及其家人带来痛苦和孤立感。在晚期癌症中，呼吸困难情况复杂，通常是多因素导致的，其严重程度与可测量的肺功能或疾病状态无关。呼吸困难临床管理方面的治疗进展有限，成功治疗仍然困难。人们对缓解呼吸困难的关注度日益增加，最近的研究表明，由一个坚定的多学科团队采用系统的、基于证据的方法可以显著改善患者生活。如果缺乏这种护理，可能是由于临床医生对慢性呼吸困难管理缺乏培训，存在治疗虚无主义，并且没有意识到除了忍耐之外还有其他选择。最佳管理包括药物治疗（主要是阿片类药物，偶尔使用氧气和抗焦虑药）和非药物干预（包括使用风扇、量身定制的运动计划以及为患者及其家人提供心理教育支持），在生命末期酌情使用胃肠外阿片类药物和镇静剂。有效的护理以患者的需求和目标为中心。呼吸困难研究的重点包括：神经影像学、新干预措施的有效性、阿片类药物的疗效、安全性和给药方案、失健状态的影响以及预防或逆转呼吸困难的效果。
