抗胆碱能药物治疗癌症晚期濒死患者的死亡喉音：多中心前瞻性队列研究。

Anticholinergic drugs for death rattle in dying patients with cancer: multicentre prospective cohort study.

机构信息

Department of Palliative Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Hyogo, Japan

Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.

出版信息

BMJ Support Palliat Care. 2023 Dec;13(4):462-471. doi: 10.1136/spcare-2022-003823. Epub 2022 Nov 10.

DOI:10.1136/spcare-2022-003823

PMID:36357162

Abstract

BACKGROUND

This study aimed to investigate the effectiveness of anticholinergics (AC) for death rattle in dying patients with cancer.

METHODS

This is a prospective cohort study enrolled Terminally ill adult (20 years or older) patients with cancer who developed substantial death rattle (Back score ≥2) from 23 palliative care units in Japan. AC treatment for death rattle was prescribed according to primary physician's decision. The primary outcome was the proportion of patients whose death rattle improved, which was defined as a Back score of ≤1. We compared the proportion of improved cases in patients treated with (AC group) and without (non-AC group) AC, controlling potential confounders by employing propensity score weighting.

RESULTS

Of the 1896 patients enrolled, we included 196 who developed a substantial death rattle. Of these, 81 received AC. 56.8% in the AC group and 35.4% in the non-AC group had an improved death rattle at 8 hours after baseline. In the weighted analysis, AC group showed significant improvements in death rattle, with an adjusted OR of 4.47 (95% CI 2.04 to 9.78; p=0.0024). All sensitivity analyses achieved essentially the same results. In the subgroup analysis, ACs were strongly associated with death rattle improvement in men, patients with lung cancer, and type 1 death rattle (adjusted OR 5.81, 8.38 and 9.32, respectively).

CONCLUSIONS

In this propensity score-weighted analysis, ACs were associated with death rattle improvement in terminally ill patients with cancer who developed substantial death rattle.

TRIAL REGISTRATION NUMBER

UMIN-CTR (UMIN00002545).

摘要

背景

本研究旨在探讨抗胆碱能药物（AC）对癌症晚期死亡患者死亡喉音的疗效。

方法

这是一项前瞻性队列研究，纳入了来自日本 23 个姑息治疗单位的终末期癌症成人（20 岁或以上）患者，这些患者出现了明显的死亡喉音（背部评分≥2）。AC 治疗死亡喉音是根据主治医生的决定开出的。主要结局是死亡喉音改善的患者比例，定义为背部评分≤1。我们通过倾向评分加权比较了接受 AC 治疗（AC 组）和未接受 AC 治疗（非 AC 组）的患者中改善病例的比例，控制了潜在的混杂因素。

结果

在纳入的 1896 例患者中，我们纳入了 196 例出现明显死亡喉音的患者。其中，81 例接受了 AC。基线后 8 小时，AC 组中有 56.8%的患者和非 AC 组中有 35.4%的患者死亡喉音得到改善。在加权分析中，AC 组的死亡喉音显著改善，调整后的 OR 为 4.47（95%CI 2.04 至 9.78；p=0.0024）。所有敏感性分析均得出了基本相同的结果。在亚组分析中，AC 在男性、肺癌患者和 1 型死亡喉音患者中与死亡喉音改善密切相关（调整后的 OR 分别为 5.81、8.38 和 9.32）。