Bausewein Claudia, Booth Sara, Higginson Irene J
Department of Palliative Care, Policy & Rehabilitation, King's College London School of Medicine, UK.
Curr Opin Support Palliat Care. 2008 Jun;2(2):95-9. doi: 10.1097/SPC.0b013e3282ffafe8.
Refractory dyspnoea is a common and difficult to treat symptom in advanced disease. Accurate assessment helps to guide treatment and prognosis.
The absence of commonly agreed assessment tools has been a significant barrier to improving care through inhibition of clinical research and limitation of clinicians' ability to assess the effectiveness of their interventions. Two recently published systematic reviews on measurement tools for breathlessness identified a variety of tools but none could be recommended as gold standard. Validation of these tools in palliative care seems more appropriate than development of new tools. For clinical purposes, the combination of a unidimensional tool to assess dyspnoea severity and a multidimensional tool to evaluate the impact on a person's quality of life seem most appropriate. This review discusses the present evidence and puts forward a strategy for assessment and measurement of the symptom in clinical practice.
Despite a variety of measurement tools none can be recommended as gold standard for the assessment of dyspnoea. A combination of unidimensional and multidimensional tools seems to be the best for clinical assessment. Measurement of dyspnoea has to be seen in context with the person's history, physical examination and diagnostic tests.
难治性呼吸困难是晚期疾病中常见且难以治疗的症状。准确评估有助于指导治疗和判断预后。
缺乏普遍认可的评估工具一直是通过抑制临床研究以及限制临床医生评估其干预措施有效性的能力来改善护理的重大障碍。最近发表的两项关于呼吸困难测量工具的系统评价确定了多种工具，但没有一种可以推荐为金标准。在姑息治疗中对这些工具进行验证似乎比开发新工具更合适。就临床目的而言，结合使用评估呼吸困难严重程度的单维度工具和评估对个人生活质量影响的多维度工具似乎最为合适。本综述讨论了现有证据，并提出了在临床实践中评估和测量该症状的策略。
尽管有多种测量工具，但没有一种可以推荐为评估呼吸困难的金标准。单维度和多维度工具相结合似乎最适合临床评估。呼吸困难的测量必须结合患者的病史、体格检查和诊断测试来进行。
