Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy.
J Pain Symptom Manage. 2012 Jun;43(6):1126-30. doi: 10.1016/j.jpainsymman.2011.06.027.
Data regarding palliative sedation at home in dying patients are lacking.
To describe the frequency, indication, and modality of palliative sedation (PS) in patients followed at home.
A retrospective analysis of home care cancer patients was performed. Patients who received PS before dying were selected and information about epidemiologic characteristics, indications, duration, drugs, and outcomes was collected.
Of 370 medical charts of patients who died at home, 49 patients received PS before dying. PS was proposed by the team, relatives, or both in 63.3%, 4.1%, and 32.6% of cases, respectively. Delirium alone or in combination with other symptoms was the most frequent indication to begin PS. Midazolam was the most frequently used drug to initiate PS (98%), at a mean dose of 28.1 mg/day, in combination with parenteral morphine (84.7%) at a mean dose of 25.4 mg/day. At the time of death, midazolam was administered in 98% of patients (mean dose 22.3 mg/day), combined with parenteral morphine in 87.8% of patients (mean dose 28.1 mg/day). Satisfaction for physicians and principal caregivers after PS was good in 46 and 48 cases, respectively.
PS at home seems to be a feasible treatment option among selected patients and makes a potentially important contribution to improving care for those who choose to die at home.
在家中临终患者的姑息性镇静治疗数据匮乏。
描述在家中接受姑息治疗的患者中姑息性镇静（PS）的频率、适应证和方式。
对在家中接受姑息治疗的癌症患者进行回顾性分析。选择在临终前接受 PS 的患者，并收集有关人口统计学特征、适应证、持续时间、药物和结局的信息。
在 370 名在家中死亡的患者的病历中，有 49 名患者在临终前接受了 PS。PS 分别由团队、亲属或两者提出，占 63.3%、4.1%和 32.6%。单独或与其他症状一起出现的谵妄是开始 PS 的最常见指征。咪达唑仑是最常用来开始 PS 的药物（98%），平均剂量为 28.1mg/天，与 84.7%的患者联合使用（平均剂量为 25.4mg/天）的肠外吗啡。在死亡时，98%的患者接受咪达唑仑治疗（平均剂量 22.3mg/天），87.8%的患者接受联合使用肠外吗啡治疗（平均剂量 28.1mg/天）。姑息治疗后，医生和主要照顾者的满意度分别为 46 例和 48 例。
PS 似乎是在家中选择患者的一种可行的治疗选择，对选择在家中死亡的患者的护理有重要贡献。
