Claessens Patricia, Menten Johan, Schotsmans Paul, Broeckaert Bert
Centre for Biomedical Ethics and Law, Catholic University of Leuven, Drongen, Belgium.
J Pain Symptom Manage. 2008 Sep;36(3):310-33. doi: 10.1016/j.jpainsymman.2007.10.004. Epub 2008 Jul 25.
The overall aim of this paper is to systematically review the following important aspects of palliative sedation: prevalence, indications, survival, medication, food and fluid intake, decision making, attitudes of physicians, family experiences, and efficacy and safety. A thorough search of different databases was conducted for pertinent research articles published from 1966 to June 2007. The following keywords were used: end of life, sedation, terminal sedation, palliative sedation, refractory symptoms, and palliative care. Language of the articles was limited to English, French, German, and Dutch. Papers reporting solely on the sedatives used in palliative care, without explicitly reporting the prevalence or intensity of sedation, and papers not reporting on primary research (such as reviews or theoretical articles) were excluded. Methodological quality was assessed according to the criteria of Hawker et al. (2002). The search yielded 130 articles, 33.8% of which were peer-reviewed empirical research studies. Thirty-three research papers and one thesis were included in this systematic review. This review reveals that there still are many inconsistencies with regard to the prevalence, the effect of sedation, food and fluid intake, the possible life-shortening effect, and the decision-making process. Further research to clarify all of this should be based on multicenter, prospective, longitudinal, and international studies that use a uniform definition of palliative sedation, and valid and reliable instruments. Only through such research will it be possible to resolve some of the important ethical issues related to palliative sedation.
患病率、适应证、生存期、用药、食物和液体摄入、决策制定、医生态度、家属体验以及疗效和安全性。对不同数据库进行了全面检索，以查找1966年至2007年6月发表的相关研究文章。使用了以下关键词：生命末期、镇静、终末期镇静、姑息性镇静、难治性症状和姑息治疗。文章语言限于英语、法语、德语和荷兰语。仅报告姑息治疗中使用的镇静剂而未明确报告镇静的患病率或强度的论文，以及未报告原始研究的论文（如综述或理论文章）被排除。根据Hawker等人（2002年）的标准评估方法学质量。检索产生了130篇文章，其中33.8%是经过同行评审的实证研究。本系统综述纳入了33篇研究论文和1篇论文。该综述表明，在患病率、镇静效果、食物和液体摄入、可能的缩短生命效果以及决策过程方面仍存在许多不一致之处。进一步的研究以阐明所有这些问题应基于多中心、前瞻性、纵向和国际性研究，这些研究使用姑息性镇静的统一定义以及有效和可靠的工具。只有通过这样的研究，才有可能解决一些与姑息性镇静相关的重要伦理问题。
