Claessens Patricia, Menten Johan, Schotsmans Paul, Broeckaert Bert
Centre for Biomedical Ethics and Law, Catholic University Leuven, Drongen, Belgium.
Palliative Care Unit, University Hospitals Leuven, Leuven, Belgium.
J Pain Symptom Manage. 2011 Jan;41(1):14-24. doi: 10.1016/j.jpainsymman.2010.04.019. Epub 2010 Sep 15.
Palliative sedation remains a much debated and controversial issue. The limited literature on the topic often fails to answer ethical questions concerning this practice.
The aim of this study was to describe the characteristics of patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death.
A prospective, longitudinal, descriptive design was used to assess data in eight PCUs. The total sample consisted of 266 patients. Information on demographics, medication, food and fluid intake, decision making, level of consciousness, and symptom experience were gathered by nurses and researchers three times a week. If patients received palliative sedation, extra information was gathered.
Of all included patients (n=266), 7.5% received palliative sedation. Sedation started, on average, 2.5 days before death and for half of these patients, the form of sedation changed over time. At the start of sedation, patients were in the end stage of their illness and needed total care. Patients were fully conscious and had very limited oral food or fluid intake. Only three patients received artificial fluids at the start of sedation. Patients reported, on average, two refractory symptoms, the most important ones being pain, fatigue, depression, drowsiness, and loss of feeling of well-being. In all cases, the patient gave consent to start palliative sedation because of increased suffering.
This study revealed that palliative sedation is only administered in exceptional cases where refractory suffering is evident and for those patients who are close to the ends of their lives. Moreover, this study supports the argument that palliative sedation has no life-shortening effect.
姑息性镇静仍然是一个备受争议的问题。关于该主题的文献有限，常常无法回答有关这种做法的伦理问题。
本研究的目的是描述在姑息治疗病房（PCU）中因难治性症状接受镇静治疗的患者从入院到死亡当天的特征。
采用前瞻性、纵向、描述性设计对8个PCU的数据进行评估。总样本包括266名患者。护士和研究人员每周三次收集有关人口统计学、用药、食物和液体摄入、决策、意识水平和症状体验的信息。如果患者接受了姑息性镇静，则收集额外信息。
在所有纳入的患者（n = 266）中，7.5%接受了姑息性镇静。镇静平均在死亡前2.5天开始，其中一半患者的镇静形式随时间变化。在镇静开始时，患者处于疾病末期，需要全面护理。患者神志清醒，口服食物或液体摄入量非常有限。只有3名患者在镇静开始时接受了人工补液。患者平均报告有两种难治性症状，最重要的是疼痛、疲劳、抑郁、嗜睡和幸福感丧失。在所有情况下，患者因痛苦加剧而同意开始姑息性镇静。
本研究表明，姑息性镇静仅在难治性痛苦明显且患者接近生命末期的特殊情况下使用。此外，本研究支持姑息性镇静没有缩短生命作用的观点。
