Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2010 Nov;40(5):761-73. doi: 10.1016/j.jpainsymman.2010.03.026.
Constipation is a highly prevalent and distressing symptom in patients with advanced, progressive illnesses. Although opioids are one of the most common causes of constipation in patients with advanced, progressive illness, it is important to note that there are many other potential etiologies and combinations of causes that should be taken into consideration when making treatment decisions. Management approaches involve a combination of good assessment techniques, preventive regimens, appropriate pharmacological treatment of established constipation, and frequent monitoring. In this vulnerable patient population, maintenance of comfort and respect for individual preferences and sensitivities should be overriding considerations when making clinical decisions. This consensus document was developed by a multidisciplinary group of leading Canadian palliative care specialists in an effort to define best practices in palliative constipation management that will be relevant and useful to health care professionals. Although a wide range of options exists to help treat constipation and prevent its development or recurrence, there is a limited body of evidence evaluating pharmacological interventions. These recommendations are, therefore, based on the best of the available evidence, combined with expert opinion derived from experience in clinical practice. This underscores the need for further clinical evaluation of the available agents to create a robust, evidence-based foundation for treatment decisions in the management of constipation in patients with advanced, progressive illness.
便秘是晚期、进展性疾病患者中一种高发且令人痛苦的症状。虽然阿片类药物是晚期、进展性疾病患者便秘的最常见原因之一，但重要的是要注意，在做出治疗决策时，还有许多其他潜在的病因和多种原因组合需要考虑。管理方法包括结合良好的评估技术、预防方案、对已确立的便秘进行适当的药物治疗以及频繁监测。在这个脆弱的患者群体中，在做出临床决策时，应优先考虑保持舒适度和尊重个人的偏好和敏感性。本共识文件由加拿大多学科领先的姑息治疗专家小组制定，旨在确定姑息治疗中便秘管理的最佳实践，这些实践将与医疗保健专业人员相关且有用。尽管有多种选择可以帮助治疗便秘并预防其发展或复发，但评估药物干预的证据有限。因此，这些建议基于现有证据中的最佳证据，并结合临床实践经验得出的专家意见。这凸显了需要进一步对现有药物进行临床评估，为晚期、进展性疾病患者便秘管理中的治疗决策提供一个强有力的、基于证据的基础。
