Simon S T, Altfelder N, Alt-Epping B, Bausewein C, Weingärtner V, Voltz R, Ostgathe C, Radbruch L, Lindena G, Nauck F
Institut für Palliative Care, Oldenburg.
Klinik für Palliativmedizin, Universitätsmedizin Göttingen.
Pneumologie. 2017 Jan;71(1):40-47. doi: 10.1055/s-0042-112837. Epub 2017 Jan 23.
Breathlessness is a common and distressing symptom in patients with advanced life-limiting disease. The aim of this study was to describe demographical and clinical characteristics of patients with breathlessness in Germany. We conducted a secondary analysis of hospice and palliative care inpatient data from 2006 to 2008. The Hospice and Palliative Care Evaluation (HOPE) is an annual prospective German survey, that includes a validated 16-item symptom-and-problem checklist (severity score 0 - 3). Characteristics of patients with or without breathlessness were compared in a pure descriptive manner. Interpretation of given p-values takes the error inflation due to multiple testing into account. Breathlessness was recorded in 2860/5320 (53.8 %) patients (mean age 67.2 years (SD 12.4), 51.4 % female, 93.6 % malignant disease (female/male lung cancer 15.7/29.5 %, breast cancer 20.3/0.3 %, colon 10.3/8.7 %). Breathless patients compared with those without breathless ness had a significantly worse functional status (ECOG 3 - 4: 78.4 % vs. 70.8 %, p < 0.001), suffered from a larger number (11.1 vs. 9.5, p < 0.001) of symptoms and the symptoms were of higher intensity (except confusion). Breathless patients had a higher risk to die during inpatient stay (43.5 % vs. 32.4 %, p < 0.001). Based on this large sample of hospice and palliative care inpatients, breathlessness is associated with a high symptom burden and shortened survival. Breathless patients need more attention in health care.
呼吸困难是晚期生命受限疾病患者常见且令人痛苦的症状。本研究旨在描述德国呼吸困难患者的人口统计学和临床特征。我们对2006年至2008年临终关怀和姑息治疗住院患者的数据进行了二次分析。临终关怀和姑息治疗评估(HOPE)是一项年度前瞻性德国调查,其中包括一份经过验证的16项症状和问题清单(严重程度评分0 - 3)。以纯描述性方式比较了有或无呼吸困难患者的特征。在解释给定的p值时考虑了多重检验导致的误差膨胀。2860/5320(53.8%)例患者记录有呼吸困难(平均年龄67.2岁(标准差12.4),51.4%为女性,93.6%为恶性疾病(女性/男性肺癌15.7/29.5%,乳腺癌20.3/0.3%,结肠癌10.3/8.7%))。与无呼吸困难的患者相比,有呼吸困难的患者功能状态明显更差(东部肿瘤协作组3 - 4级:78.4%对70.8%,p<0.001),症状数量更多(11.1对9.5,p<0.001)且症状强度更高(除意识模糊外)。有呼吸困难的患者住院期间死亡风险更高(43.5%对32.4%,p<0.001)。基于这一大量的临终关怀和姑息治疗住院患者样本,呼吸困难与高症状负担和生存期缩短相关。呼吸困难患者在医疗保健中需要更多关注。