Centre for Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom.
J Pain Symptom Manage. 2010 Jan;39(1):44-53. doi: 10.1016/j.jpainsymman.2009.06.007. Epub 2009 Oct 24.
Continuous deep sedation (CDS) until death can form an effective part of palliative care. In The Netherlands and Belgium, CDS is sometimes regarded as an alternative to euthanasia, and the involvement of palliative care specialists is low. Provision of CDS through opioids alone is not recommended.
This study investigates the use of CDS in the United Kingdom.
A survey of 8,857 doctors, of whom 3,733 (42%) replied, with 2,923 reporting on their last patient who died.
In total, 18.7% (17.3-20.1) of the doctors attending a dying patient reported the use of CDS. CDS was more likely when patients were younger or were dying of cancer. Specialists in care of the elderly were least likely to report the use of CDS; doctors in other hospital specialties were most likely to report its use. CDS was associated with a higher rate of requests from patients or relatives for a hastened death and with a greater incidence of other end-of-life decisions containing some intent to end life by the doctor. Doctors supporting legalization of euthanasia or physician-assisted suicide, or who were nonreligious, were more likely to report using CDS. There was palliative care team involvement in half of all CDS cases, and prescription of opioids alone for sedation occurred in one-fifth of the cases but was not reported by specialists in palliative care.
This study provides baseline data for monitoring future trends in the United Kingdom and highlights the need for a fuller understanding of the circumstances in which CDS occurs in particular care settings.
持续深度镇静（CDS）直至死亡可以成为姑息治疗的有效组成部分。在荷兰和比利时，CDS 有时被视为安乐死的替代方法，而姑息治疗专家的参与度较低。单独使用阿片类药物提供 CDS 并不被推荐。
本研究调查了英国 CDS 的使用情况。
对 8857 名医生进行了调查，其中 3733 名（42%）医生做出了回应，其中 2923 名医生报告了他们最近去世的患者的情况。
在接受临终患者治疗的医生中，共有 18.7%（17.3-20.1）报告使用了 CDS。当患者年龄较小或死于癌症时，CDS 更有可能被使用。老年护理专家最不可能报告使用 CDS；其他医院专科的医生最有可能报告使用 CDS。CDS 与患者或家属要求加速死亡的请求率较高以及医生更有可能做出其他包含结束生命意图的临终决定有关。支持安乐死或医师协助自杀合法化的医生，或无宗教信仰的医生，更有可能报告使用 CDS。在所有 CDS 病例中，有一半有姑息治疗团队参与，单独开具阿片类药物用于镇静的情况占五分之一，但姑息治疗专家并未报告这种情况。
本研究为监测英国未来的趋势提供了基线数据，并强调需要更全面地了解 CDS 在特定护理环境中发生的情况。
