在无反应性姑息治疗患者中突破性药物的应用：适应证、实践和疗效。
Breakthrough Medication in Unresponsive Palliative Care Patients: Indications, Practice, and Efficacy.
机构信息
Palliative Care Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.
Palliative Care Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia; School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
出版信息
J Pain Symptom Manage. 2018 Dec;56(6):944-950. doi: 10.1016/j.jpainsymman.2018.08.020. Epub 2018 Sep 7.
CONTEXT
An unresponsive patient's need and their response to breakthrough medication is determined by clinical assessment and/or observational measures. How closely these methods match the patient's experience is unknown.
OBJECTIVES
Determine the efficacy and effectiveness of breakthrough medication in unresponsive patients and the perception of patient comfort made by nurses and family.
METHODS
A prospective study of breakthrough medication in unresponsive patients. The Richmond Agitation-Sedation Scale (RASS) and Patient Comfort Score (PCS) were compared with time-matched Bispectral Index (BIS) Scores. The effects of opioid vs. opioid + benzodiazepine breakthroughs and the relation between synchronous nurse and family measurements of the PCS were evaluated. Analysis of variance and paired t-tests were used for BIS analyses and nonparametric Mann-Whitney tests for RASS and PCS.
RESULTS
Significant reductions at 30 and 60 minutes after breakthrough medication were noted for BIS (P < 0.0004), RASS (P = 0.043 and 0.004, respectively), and PCS (P < 0.0004). A direct comparison of the effect of opioid breakthrough medication vs. opioid plus benzodiazepine revealed no significant difference (BIS, P = 0.512; RASS, P = 0.195; PCS, P = 0.119). Of the 157 synchronous nurse and family measures of patient comfort, families rated patient discomfort significantly higher than nurses (P < 0.0004).
CONCLUSION
This study provides additional evidence for the efficacy and effectiveness of breakthrough medication and the merit of observational measures in determining a patient's response. The onset of action is evident at 30 minutes after injection. Family assessment of patient comfort may be more nuanced than that of nurses, and they not uncommonly rate patient discomfort higher than nurses.
背景
无法响应的患者对突破性药物的需求及其反应是通过临床评估和/或观察性措施来确定的。这些方法与患者体验的吻合程度尚不清楚。
目的
确定无法响应的患者中突破性药物的疗效和有效性，以及护士和家属对患者舒适度的感知。
方法
对无法响应的患者中突破性药物的前瞻性研究。将 Richmond 镇静躁动评分（RASS）和患者舒适度评分（PCS）与时间匹配的脑电双频指数（BIS）评分进行比较。评估阿片类药物与阿片类药物+苯二氮䓬类药物突破性治疗的效果，以及护士和家属同步测量 PCS 的相关性。使用方差分析和配对 t 检验进行 BIS 分析，非参数 Mann-Whitney 检验进行 RASS 和 PCS 分析。
结果
突破性药物治疗后 30 分钟和 60 分钟时，BIS（P < 0.0004）、RASS（P = 0.043 和 0.004）和 PCS（P < 0.0004）均有显著降低。阿片类药物突破性药物治疗与阿片类药物+苯二氮䓬类药物治疗效果的直接比较显示无显著差异（BIS，P = 0.512；RASS，P = 0.195；PCS，P = 0.119）。在 157 次同步护士和家属对患者舒适度的测量中，家属认为患者不适的评分明显高于护士（P < 0.0004）。
结论
本研究为突破性药物的疗效和有效性以及观察性措施在确定患者反应方面的优势提供了额外的证据。注射后 30 分钟即可观察到药物的起效时间。家属对患者舒适度的评估可能比护士更细致入微，他们经常比护士更频繁地评估患者的不适。
Zotero 插件