Palliative Care Department, Higashi Sapporo Hospital, Sopporo, Japan.
J Palliat Med. 2013 Feb;16(2):185-9. doi: 10.1089/jpm.2012.0233. Epub 2013 Jan 17.
Current discrepancies in the practice of artificial hydration therapy for terminally ill cancer patients have the potential to cause serious clinical problems.
The study's purpose was to explore the influence of hydration volume on the sings during the last three weeks of life in terminally ill cancer patients.
This was a prospective, observational study of 75 consecutive terminally ill patients with abdominal malignancies during the last four years. Primary responsible physicians evaluated the severity of membranous dehydration (calculated on the basis of three physical findings), peripheral edema (calculated on the basis of seven physical findings), ascites and pleural effusion (rated as physically undetectable to symptomatic), bronchial secretion, and hyperactive delirium.
Patients were classified into two groups: the hydration group (n=32), receiving 1000 mL or more of artificial hydration per day, one and three weeks before death, and the nonhydration group (n=43). The percentage of patients with deterioration in dehydration score in the final three weeks was significantly higher in the nonhydration group than in the hydration group (35% versus 13%, p=0.027), while the percentages of patients whose symptom scores for edema, ascites, and bronchial secretion increased were significantly higher in the hydration group than in the nonhydration group (57% versus 33%, p=0.040; 34% versus 14%, p=0.037; 41% versus 19%, p=0.036, respectively). There were no significant differences in the degree of pleural effusion or the prevalence of hyperactive delirium between these groups.
The potential benefits of artificial hydration therapy should be balanced with the risk of worsening fluid retention signs.
目前，终末期癌症患者进行人工水化治疗的实践存在差异，这有可能导致严重的临床问题。
本研究旨在探讨终末期癌症患者生命最后三周的水化量对其生命体征的影响。
这是一项前瞻性、观察性研究，纳入了过去四年中 75 例连续的终末期腹部恶性肿瘤患者。主要负责医生评估了膜性脱水（基于 3 项体格检查结果计算）、外周水肿（基于 7 项体格检查结果计算）、腹水和胸腔积液（分别为无症状和有症状）、支气管分泌物和活跃性谵妄的严重程度。
患者被分为两组：水化组（n=32），在死亡前一周和前三天每天接受 1000 毫升或更多的人工水化；非水化组（n=43）。在最后三周，非水化组中脱水评分恶化的患者比例明显高于水化组（35%比 13%，p=0.027），而水肿、腹水和支气管分泌物症状评分增加的患者比例在水化组明显高于非水化组（57%比 33%，p=0.040；34%比 14%，p=0.037；41%比 19%，p=0.036）。两组胸腔积液程度或活跃性谵妄的发生率均无显著差异。
人工水化治疗的潜在益处应与液体潴留体征恶化的风险相平衡。
