De Zorggroep, Region Venlo (EBC), Venlo, The Netherlands.
J Am Geriatr Soc. 2010 Sep;58(9):1671-8. doi: 10.1111/j.1532-5415.2010.03014.x. Epub 2010 Aug 24.
To study the practice of continuous palliative sedation (CPS) by Dutch nursing home physicians in 2007.
A structured retrospective questionnaire.
Nationwide nursing home physician study in the Netherlands.
One thousand two hundred fifty-four nursing home physicians received a questionnaire concerning their last case of CPS in 2007; 54% (n=675) responded.
Characteristics of CPS and requests for euthanasia were measured.
Three hundred sixteen patients were described. The majority had cancer or dementia. The most-reported refractory symptoms were pain (52%), anxiety (44%), exhaustion (44%), dyspnea (40%), delirium (24%), loss of dignity (18%), and existential distress (16%). In 98% of cases, CPS was aimed at symptom relief. Of patients with cancer, 17% had previously requested euthanasia. The mean starting dose of midazolam was 31 mg every 24 hours (range 0-240 mg/24 h), and the mean end dose was 48 mg every 24 hours (range 0-480 mg/24 h).
In addition to physical symptoms, anxiety, exhaustion, loss of dignity, and existential distress are often mentioned as refractory symptoms in the decision to start CPS by nursing home physicians. Furthermore, close to one in five patients with cancer had made a previous request for euthanasia. The dosage range of midazolam in this study fits the recommendations of the Dutch national guideline on palliative sedation, although international studies show smaller dosage ranges. Finally, prospective research about the acceptability and assessment of nonphysical symptoms as indications for CPS is recommended.
研究 2007 年荷兰护理院医生实施持续缓和性镇静（CPS）的实践情况。
一项结构化的回顾性问卷调查。
荷兰全国范围内的护理院医生研究。
1254 名护理院医生收到了一份关于他们在 2007 年最后一例 CPS 的问卷；54%（n=675）做出了回应。
CPS 的特征和安乐死请求的测量。
描述了 316 例患者。大多数患有癌症或痴呆症。报告最多的难治性症状是疼痛（52%）、焦虑（44%）、疲惫（44%）、呼吸困难（40%）、谵妄（24%）、失去尊严（18%）和存在困境（16%）。在 98%的情况下，CPS 旨在缓解症状。在患有癌症的患者中，17%的人曾请求安乐死。咪达唑仑的平均起始剂量为每 24 小时 31 毫克（范围 0-240 毫克/24 小时），平均终末剂量为每 24 小时 48 毫克（范围 0-480 毫克/24 小时）。
除了身体症状外，焦虑、疲惫、失去尊严和存在困境在护理院医生决定开始 CPS 时经常被提及为难治性症状。此外，近五分之一的癌症患者曾提出过安乐死请求。本研究中咪达唑仑的剂量范围符合荷兰缓和性镇静国家指南的建议，尽管国际研究显示剂量范围较小。最后，建议对非身体症状作为 CPS 适应证的可接受性和评估进行前瞻性研究。
