Yan Chai Hospital-Hong Kong Baptist University Clinical Centre for Training and Research in Chinese Medicine (West Kowloon), Hong Kong, SAR, China.
Support Care Cancer. 2013 Jan;21(1):149-56. doi: 10.1007/s00520-012-1504-x. Epub 2012 Jun 1.
This study aimed to evaluate the bowel habit and laxative use in advanced cancer patients with constipation in palliative care unit.
It was a cross-sectional study using a self-designed questionnaire.
A total of 225 patients were analysed. Among all patients, 92.0 % (207 patients) had any intervention for relief of constipation, including laxatives, suppositories, enemas, digital evacuation and Chinese herbal medicine, and 65.3 % (147 patients) were on laxatives prescribed by our doctors. The severity of constipation as assessed by the constipation visual analogue scale (CVAS) (0-7, 7 = most severe) was reported as no constipation (0-1) in 19.6 % of patients, constipation (2-4) in 50.7 % and severe constipation (5-7) in 29.8 %. More patients with severe constipation, as compared with patients with constipation and no constipation, reported inadequate pushing force (83.6 vs. 47.4 vs. 6.8 %), sense of incomplete defecation (40.3 vs. 14.9 vs. 6.8 %) and difficult defecation (58.2 vs. 26.3 vs. 0 %), all p < 0.001, but there was no difference in stool types as assessed by Bristol Stool Scale (p = 0.303). Patients not on opioids, as compared with patients on strong opioids, had similar CVAS scores and description of constipation but had least laxatives prescribed (60.2 vs. 78.9 %, p = 0.012).
Evaluation of constipation should not rely on stool form or consistency alone, and patient's description of constipation is worth consideration. Constipation is also a problem in patients not on opioids and more attention is required. A revisit to existing guidelines is needed.
本研究旨在评估姑息治疗病房中患有便秘的晚期癌症患者的肠道习惯和泻药使用情况。
这是一项使用自行设计的问卷进行的横断面研究。
共分析了 225 名患者。所有患者中，92.0%（207 名）接受了任何缓解便秘的干预措施，包括泻药、栓剂、灌肠、手指清除和中药，65.3%（147 名）使用了我们医生开的泻药。便秘视觉模拟量表（CVAS）（0-7，7=最严重）评估的便秘严重程度，无便秘（0-1）的患者占 19.6%，便秘（2-4）的患者占 50.7%，严重便秘（5-7）的患者占 29.8%。与便秘和无便秘的患者相比，更多严重便秘的患者报告排便无力（83.6%比 47.4%比 6.8%）、排便不尽感（40.3%比 14.9%比 6.8%）和排便困难（58.2%比 26.3%比 0%），所有差异均有统计学意义（p<0.001），但布里斯托粪便分类法（Bristol Stool Scale）评估的粪便类型无差异（p=0.303）。与使用强阿片类药物的患者相比，未使用阿片类药物的患者的 CVAS 评分和便秘描述相似，但开具的泻药最少（60.2%比 78.9%，p=0.012）。
评估便秘不应仅依赖粪便形态或稠度，患者对便秘的描述值得考虑。非阿片类药物患者也存在便秘问题，需要给予更多关注。需要重新审视现有的指南。
