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养老院姑息治疗患者症状强度、治疗程序及治疗的前瞻性评估

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes.

作者信息

Puente-Fernández Daniel, Roldán-López Concepción B, Campos-Calderón Concepción P, Hueso-Montoro Cesar, García-Caro María P, Montoya-Juarez Rafael

机构信息

Doctoral Program of Clinical Medicine and Public Health, University of Granada, 18071 Granada, Spain.

Department of Statistics and Operational Research, Faculty of Medicine, University of Granada, 1016 Granada, Spain.

出版信息

J Clin Med. 2020 Mar 10;9(3):750. doi: 10.3390/jcm9030750.

Abstract

The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms ( < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up ( < 0.05). The use of aerosol sprays ( = 0.008), oxygen therapy ( < 0.001), opioids ( < 0.001), antibiotics ( = 0.004), and bronchodilators ( = 0.003) increased in the last week of life. Peripheral venous catheters ( = 0.022), corticoids ( = 0.007), antiemetics ( < 0.001), and antidepressants ( < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.

摘要

本研究的目的是评估晚期慢性病养老院患者的症状强度,以及他们接受的任何治疗和治疗程序。在六家养老院进行了为期五个月的多中心前瞻性研究。一名护士培训师从姑息治疗患者中随机抽取样本纳入研究。对埃德蒙顿症状评估量表、治疗程序和治疗进行了评估。使用参数检验和非参数检验来评估逐月差异以及死亡患者和未死亡患者之间的差异。总共评估了107名居民。随访结束时,39人(34.6%)死亡。在生命的最后一周,所有症状的强度均有所增加(<0.050)。随访中死亡患者的症状更为严重(<0.05)。在生命的最后一周,气雾剂喷雾(=0.008)、氧疗(<0.001)、阿片类药物(<0.001)、抗生素(=0.004)和支气管扩张剂(=0.003)的使用有所增加。外周静脉导管(=0.022)、皮质类固醇(=0.007)、止吐药(<0.001)和抗抑郁药(<0.05)在死亡患者中使用得更多。总之,在这种临床环境中,应谨慎考虑治疗程序(如导尿管、外周静脉导管置入和肠内喂养)和药物(如抗生素、抗焦虑药和新的抗抑郁药处方)的使用。

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