Senderovich Helen, Waicus Sarah, Mokenela Keisa
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Baycrest Hospital, Toronto, Ontario, Canada.
Case Rep Oncol. 2022 Mar 10;15(1):218-224. doi: 10.1159/000522558. eCollection 2022 Jan-Apr.
The selected case study aimed to evaluate the role of phenobarbital as a drug of choice in end-of-life (EOL) settings. Phenobarbital is efficacious in management of EOL seizures and agitation, can be easily administered via different modes, and utilized in various palliative care (PC) settings. Mrs. X., 90-year-old female with a history of glioblastoma multiforme, was a resident of long-term care, residing in a PC unit. She presented with illness progression which resulted in an increased frequency of generalized tonic-clonic seizures which were managed initially with phenytoin. Due to the advanced stage of the illness and significant decline in the patient's cognitive and physical status, oral route and intravenous access were lost, and phenytoin became not an option for seizure control. She was then rotated to subcutaneous phenobarbital, as a result, starting at 30 mg once a day. The dose needed to be titrated up in 15 mg increments to achieve adequate seizure control, and she stabilized on 60 mg of subcutaneous phenobarbital after 2 days. No serious adverse skin reactions were noted with the use of phenobarbital, and it did not abruptly end a patient's life when used at appropriate doses. The sedative properties of phenobarbital had benefited Mrs. X and allowed her to be comfortable approaching EOL with glioblastoma multiforme.
所选的案例研究旨在评估苯巴比妥作为临终（EOL）情况下首选药物的作用。苯巴比妥在控制临终癫痫发作和躁动方面有效，可通过不同方式轻松给药，并可用于各种姑息治疗（PC）环境。X女士，90岁女性，有多形性胶质母细胞瘤病史，是一名长期护理机构的居民，住在姑息治疗病房。她的病情进展导致全身性强直阵挛发作频率增加，最初用苯妥英钠进行治疗。由于疾病处于晚期且患者的认知和身体状况显著下降，口服途径和静脉通路均已丧失，苯妥英钠不再是控制癫痫发作的选择。随后她改用皮下注射苯巴比妥，起始剂量为每日30毫克。剂量需要以15毫克的增量进行滴定以实现充分的癫痫控制，2天后她在皮下注射60毫克苯巴比妥时病情稳定。使用苯巴比妥未发现严重的皮肤不良反应，并且在适当剂量使用时不会突然结束患者的生命。苯巴比妥的镇静特性使X女士受益，并使她在多形性胶质母细胞瘤临终时感到舒适。
