COVID-19 患者在第一波大流行期间于医院死亡时的症状、症状缓解和支持。
Symptoms, symptom relief and support in COVID-19 patients dying in hospitals during the first pandemic wave.
机构信息
Department of Radiation Sciences, Umeå University, SE-90187, Umeå, Sweden.
Palliative Care Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.
出版信息
BMC Palliat Care. 2021 Jul 1;20(1):102. doi: 10.1186/s12904-021-00785-4.
BACKGROUND
At the time of the first wave of the COVID-19 pandemic in Sweden, little was known about how effective our regular end-of-life care strategies would be for patients dying from COVID-19 in hospitals. The aim of the study was to describe and evaluate end-of-life care for patients dying from COVID-19 in hospitals in Sweden up until up until 12 November 2020.
METHODS
Data were collected from the Swedish Register of Palliative Care. Hospital deaths during 2020 for patients with COVID-19 were included and compared to a reference cohort of hospital patients who died during 2019. Logistic regression was used to compare the groups and to control for impact of sex, age and a diagnosis of dementia.
RESULTS
The COVID-19 group (1476 individuals) had a lower proportion of women and was older compared to the reference cohort (13,158 individuals), 81.8 versus 80.6 years (p < .001). Breathlessness was more commonly reported in the COVID-19 group compared to the reference cohort (72% vs 43%, p < .001). Furthermore, anxiety and delirium were more commonly and respiratory secretions, nausea and pain were less commonly reported during the last week in life in the COVID-19 group (p < .001 for all five symptoms). When present, complete relief of anxiety (p = .021), pain (p = .025) and respiratory secretions (p = .037) was more often achieved in the COVID-19 group. In the COVID-19 group, 57% had someone present at the time of death compared to 77% in the reference cohort (p < .001).
CONCLUSIONS
The standard medical strategies for symptom relief and end-of-life care in hospitals seemed to be acceptable. Symptoms in COVID-19 deaths in hospitals were relieved as much as or even to a higher degree than in hospitals in 2019. Importantly, though, as a result of closing the hospitals to relatives and visitors, patients dying from COVID-19 more frequently died alone, and healthcare providers were not able to substitute for absent relatives.
背景
在 COVID-19 大流行的第一波期间，对于在医院死于 COVID-19 的患者，我们的常规临终关怀策略将如何有效，知之甚少。本研究的目的是描述和评估截至 2020 年 11 月 12 日在瑞典医院死于 COVID-19 的患者的临终关怀。
方法
数据来自瑞典姑息治疗登记处。纳入 2020 年死于 COVID-19 的医院患者，并与 2019 年死于医院的参考队列进行比较。使用逻辑回归比较两组，并控制性别、年龄和痴呆诊断的影响。
结果
与参考队列（13158 人）相比，COVID-19 组（1476 人）女性比例较低，年龄较大，分别为 81.8 岁和 80.6 岁（p<0.001）。与参考队列（72%比 43%，p<0.001）相比，COVID-19 组更常报告呼吸困难。此外，在生命的最后一周，焦虑和谵妄更常见，而呼吸分泌物、恶心和疼痛更少见（所有五种症状均 p<0.001）。在 COVID-19 组中，当存在时，焦虑（p=0.021）、疼痛（p=0.025）和呼吸分泌物（p=0.037）的完全缓解更为常见。在 COVID-19 组中，57%的人在死亡时有人在场，而参考队列中为 77%（p<0.001）。
结论
医院缓解症状和临终关怀的标准医疗策略似乎是可以接受的。与 2019 年相比，医院 COVID-19 死亡患者的症状缓解程度相同或更高。重要的是，由于将医院对亲属和访客关闭，COVID-19 死亡患者更频繁地独自死亡，而医护人员无法替代缺席的亲属。
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