Bogaardt Hans, Veerbeek Laetitia, Kelly Katherine, van der Heide Agnes, van Zuylen Lia, Speyer Renée
Speech Pathology, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia,
Dysphagia. 2015 Apr;30(2):145-51. doi: 10.1007/s00455-014-9590-1. Epub 2014 Dec 23.
Swallowing problems are reported to be a common finding in patients who receive palliative care. In existing literature, the incidence of swallowing problems is mostly described in small numbers of patients at the start of the palliative phase. As we hypothesized that the incidence of dysphagia might increase as the palliative phase progresses, this study describes the incidence of swallowing problems and related problems in 164 unsedated patients at the end of the palliative phase, defined by the last 72 h before their death. To determine the incidence of swallowing problems and related problems, questionnaires were completed bereaved by relatives and nursing staff. Our data shows that in the palliative phase the incidence of swallowing problems can be as high as 79 %. A significant correlation was found between swallowing problems and reduced psycho-social quality of life as assessed by nursing staff (ρ = -.284). Overall the nursing staff rated the incidence and severity of swallowing problems (and related problems like frequent coughing, loss of appetite, and problems with oral secretions) lower than the relatives. This study suggests that incidence of swallowing problems at the end of the palliative phase is high and that these difficulties may not only result in discomfort for patients, but also can raise concern for caregivers. More information and education on management of swallowing problems in palliative settings might be needed for both relatives and nursing staff. However, the data also suggest that any intervention should be proportional to the level of distress caused by the intervention.
据报道，吞咽问题在接受姑息治疗的患者中很常见。在现有文献中，吞咽问题的发生率大多是在姑息治疗阶段开始时在少数患者中描述的。由于我们假设吞咽困难的发生率可能会随着姑息治疗阶段的进展而增加，本研究描述了164例未使用镇静剂的患者在姑息治疗阶段结束时（定义为死亡前最后72小时）吞咽问题及相关问题的发生率。为了确定吞咽问题及相关问题的发生率，亲属和护理人员完成了问卷调查。我们的数据显示，在姑息治疗阶段，吞咽问题的发生率可能高达79%。护理人员评估发现，吞咽问题与心理社会生活质量下降之间存在显著相关性（ρ = -0.284）。总体而言，护理人员对吞咽问题（以及频繁咳嗽、食欲不振和口腔分泌物问题等相关问题）的发生率和严重程度的评分低于亲属。这项研究表明，姑息治疗阶段结束时吞咽问题的发生率很高，这些困难不仅可能给患者带来不适，也可能引起护理人员的担忧。亲属和护理人员可能都需要更多关于姑息治疗环境中吞咽问题管理的信息和教育。然而，数据也表明，任何干预措施都应与干预所造成的痛苦程度相称。
