Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Curr Opin Support Palliat Care. 2012 Sep;6(3):365-70. doi: 10.1097/SPC.0b013e328356ab4a.
This review aims to update healthcare providers on the role of parenteral nutrition/hydration in terminal patients and highlight recent research.
Cachexia is felt to be refractory to treatment at the last stages of life. The majority of terminally ill patients will derive no benefit from parenteral nutrition with some exceptions including patients with a good functional status and a nonfunctional gastrointestinal tract or a slow growing tumor.Dehydration can potentially be reversible in patients at the end of life. However, recent research examining parenteral hydration reveals no clear clinical benefits on symptom burden or survival for terminally ill cancer patients with the exception of possibly reversing the complication of delirium.
Hydration and nutrition are essential for the maintenance of life. In patients at the end of life, artificial hydration and nutrition pose clinical, ethical, and logistical dilemmas. No strong evidence exists supporting the use of parenteral hydration/nutrition for the majority of terminally ill patients; however, a subset of patients may derive some benefit. Uncertainty about determining prognosis, psychosocial factors, and perceptions of perceived benefits results in artificial nutrition/hydration being initiated in terminally ill patients. Discontinuation of artificial support can result in distress for patients, family members, and healthcare providers.
本文旨在为医疗保健提供者更新关于终末期患者肠外营养/补液的作用，并强调最近的研究进展。
在生命的最后阶段，恶病质被认为是难治的。大多数终末期患者从肠外营养中获益甚微，但也有一些例外，包括功能状态良好且无功能性胃肠道或生长缓慢的肿瘤的患者。在生命末期，脱水可能是可逆的。然而，最近研究表明，肠外补液对于终末期癌症患者的症状负担或生存没有明显的临床获益，除了可能逆转谵妄等并发症。
水合作用和营养是维持生命所必需的。在生命末期的患者中，人工补液和营养会带来临床、伦理和实际操作方面的难题。目前没有强有力的证据支持大多数终末期患者使用肠外补液/营养，但某些患者可能从中受益。对预后、心理社会因素和预期益处的认知不确定性导致终末期患者开始接受人工营养/补液。停止人工支持可能会给患者、家属和医护人员带来困扰。
