Shreves Ashley, Pour Trevor R., Gupta Nachi, Nusbaum Jeffrey
Emergency Physician, Ochsner Medical Center, New Orleans, LA
Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Emerg Med Pract. 2018 Jul 1;20(Suppl 7):1-2.
Dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care in the emergency department. Many underlying disease states and acute illnesses cause shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and hand-held fans may also be used. Benzodiazepines may also be helpful in select patients. The early involvement of palliative medicine specialists and/or hospice services for dying patients can facilitate optimal symptom management and transitions of care. [Points & Pearls is a digest of Emergency Medicine Practice.]
呼吸困难是临终患者经历的最痛苦症状之一，也是此类患者前往急诊科就诊的常见原因。许多潜在疾病状态和急性疾病会导致临终时呼吸急促，治疗往往以对症治疗为主而非诊断性治疗，尤其是对于那些以舒适为最重要目标的患者。阿片类药物是该人群中缓解呼吸困难最有效且研究最广泛的药物，同时也可使用辅助疗法，如吸氧、无创正压通气和手持风扇。苯二氮䓬类药物对部分患者可能也有帮助。临终患者早期介入姑息医学专家和/或临终关怀服务有助于实现最佳症状管理和护理过渡。[要点与经验总结是《急诊医学实践》的摘要。]
