Hosoi Takahiro, Ozone Sachiko, Hamano Jun
Department of General Medicine, Division of Clinical Medicine, Kamisu Clinical Education and Training Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of General Medicine, Division of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Ann Palliat Med. 2020 Sep;9(5):2678-2683. doi: 10.21037/apm-20-1054. Epub 2020 Aug 19.
The prediction of impending death is important for providing appropriate end-of-life care; however, limited information is currently available on the signs of impending death in non-cancer patients. Furthermore, although vital signs are routinely measured in clinical practice, changes in vital signs in the dying phase in non-cancer patients have not yet been elucidated in detail.
We herein conducted a retrospective study to clarify changes in vital signs before death in noncancer patients. Non-cancer patients who died in a hospital in Japan between April 2017 and April 2018 were examined. Vital signs for up to seven days before death were analyzed, with the average value of each vital sign approximately every twelve hours being plotted. We divided data into two periods: from days -7 to -4 and from day -3 to death. We used a linear mixed model in the two periods, and t-tests were performed to assess whether the gradient of the line across the time variable significantly differed from zero.
Data from 47 non-cancer patients were analyzed. Systolic blood pressure (P<0.001), diastolic blood pressure (P<0.001), and oxygen saturation (P=0.001) significantly decreased from day -3 to death, whereas no significant changes were noted in any vital sign in days -7 to -4.
Based on the present results, changes in blood pressure and oxygen saturation may be useful indicators of prognosis within three days of death. Further research on clinical signs and their diagnostic characteristics for impending death in non-cancer patients is needed.
对即将死亡进行预测对于提供适当的临终关怀很重要；然而，目前关于非癌症患者即将死亡迹象的信息有限。此外，尽管生命体征在临床实践中是常规测量的，但非癌症患者临终阶段生命体征的变化尚未得到详细阐明。
我们在此进行了一项回顾性研究，以阐明非癌症患者死亡前生命体征的变化。对2017年4月至2018年4月期间在日本一家医院死亡的非癌症患者进行了检查。分析了死亡前长达七天的生命体征，每隔约十二小时绘制每个生命体征的平均值。我们将数据分为两个时期：从第-7天至-4天以及从第-3天至死亡。我们在这两个时期使用线性混合模型，并进行t检验以评估跨时间变量的直线斜率是否显著不同于零。
分析了47例非癌症患者的数据。从第-3天至死亡，收缩压（P<0.001）、舒张压（P<0.001）和血氧饱和度（P=0.001）显著下降，而在第-7天至-4天任何生命体征均未观察到显著变化。
基于目前的结果，血压和血氧饱和度变化可能是死亡前三天内预后的有用指标。需要对非癌症患者即将死亡的临床体征及其诊断特征进行进一步研究。
