Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia.
Department of Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia.
J Pain Symptom Manage. 2018 Jan;55(1):22-30. doi: 10.1016/j.jpainsymman.2017.08.004. Epub 2017 Aug 10.
Opioids and sedatives are the cornerstone of symptom management in the end-of-life patients, but undertreatment is a common problem. Although several studies explored the individual effect of opioids, anxiolytics, and antipsychotics on survival, not much is known regarding their combined use. As these drugs share similar and potentially fatal side effects, primarily respiratory depression which occurs more often during night-hours, it is crucial to explore whether their interaction poses a danger for fragile hospice patients.
To analyze the relationship of a combination of opioids, anxiolytics, and antipsychotics on survival and the change of night-time death percentage.
A retrospective study of 765 consecutive patients admitted to hospice in Croatia over the period of four years (2013-2017). The main outcome was the total length of survival of hospice patients regarding different drug combination, along with night-time death percentage.
Different combinations of opioids, anxiolytics, and antipsychotics were associated with longer survival in hospice compared with patients using no such drugs. When we included different parameters which affected overall survival into a multivariate analysis, only the patients who had the combination of both opioids, anxiolytics, and antipsychotics in their regular therapy were associated with longer survival in hospice (11 vs. five days, hazard ratio 0.54, P < 0.001). No combination of opioids, anxiolytics, and antipsychotics significantly changed the night-time death percentage.
This research supports the safety of opioids, anxiolytics, and antipsychotics in the hospice setting when used both individually as well as in combination.
在临终患者的症状管理中，阿片类药物和镇静剂是基石，但治疗不足是一个常见问题。尽管有几项研究探讨了阿片类药物、抗焦虑药和抗精神病药对生存的单独影响，但对于它们的联合使用知之甚少。由于这些药物具有相似的、潜在致命的副作用，主要是呼吸抑制，这种情况在夜间更为常见，因此有必要探讨它们的联合使用是否对脆弱的临终关怀患者构成危险。
分析阿片类药物、抗焦虑药和抗精神病药联合使用对生存的影响以及夜间死亡百分比的变化。
对克罗地亚 4 年来（2013-2017 年）连续入住临终关怀的 765 例患者进行回顾性研究。主要结局是不同药物组合对临终关怀患者总生存时间的影响，以及夜间死亡百分比。
与未使用此类药物的患者相比，阿片类药物、抗焦虑药和抗精神病药的不同组合与临终关怀患者的生存时间延长相关。当我们将影响总生存的不同参数纳入多变量分析时，只有在常规治疗中联合使用阿片类药物、抗焦虑药和抗精神病药的患者与临终关怀中的生存时间延长相关（11 天与 5 天，风险比 0.54，P<0.001）。阿片类药物、抗焦虑药和抗精神病药的任何组合均未显著改变夜间死亡百分比。
本研究支持在临终关怀环境中单独使用和联合使用阿片类药物、抗焦虑药和抗精神病药的安全性。
