通过评估不适程度来评估姑息性镇静对晚期癌症患者的疗效：一项前瞻性、国际性、多中心观察性研究。
Assessment of the efficacy of palliative sedation in advanced cancer patients by evaluating discomfort levels: a prospective, international, multicenter observational study.
作者信息
Rijpstra Maaike, Vissers Kris, Belar Alazne, Van der Elst Michael, Surges Séverine Marie, Adile Claudio, Rojí Rocío, Grassi Yasmine, Bronkhorst Ewald, Mercadante Sebastiano, Radbruch Lukas, Menten Johan, Centeno Carlos, Kuip Evelien, Hasselaar Jeroen
机构信息
Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein 10, Nijmegen, 6500HB, the Netherlands.
Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
出版信息
BMC Med. 2024 Dec 31;22(1):608. doi: 10.1186/s12916-024-03829-7.
BACKGROUND
Palliative sedation involves the intentional proportional lowering of the level of consciousness in patients with life-limiting disease who are experiencing refractory suffering. The efficacy of palliative sedation needs to be monitored to ensure patient comfort. The aim of this study was to evaluate the efficacy using discomfort levels combined with sedation/agitation levels.
METHODS
In this prospective observational study, adult patients with advanced malignancies were recruited from hospice units, palliative care units, and hospital wards in five European countries. Health care professionals used proxy observations of discomfort levels (Discomfort Scale-Dementia of Alzheimer Type, range 0-27) and sedation/agitation levels (Richmond Agitation-Sedation Scale modified for palliative care inpatients), range - 5 to + 4) to evaluate the efficacy of palliative sedation.
RESULTS
In 78 participants, discomfort levels were monitored during palliative sedation. The mean discomfort score before start was 9.4 points (95% CI 8.3-10.5), which showed a significant decrease of 6.0 points (95% CI 4.8-7.1) after start of sedation for the total sedation period. In the multivariable analysis, no significant factors influencing baseline discomfort levels were identified. The discomfort and depth of sedation scores were found to be positively correlated, with an r of 0.72 (95% CI 0.61-0.82). The internal consistency of the discomfort scale was good (0.83), but the "Noisy breathing" item was less informative of the total discomfort score.
CONCLUSIONS
The efficacy of palliative sedation can be evaluated by measuring discomfort levels combined with sedation/agitation levels. The measurement of discomfort levels might provide a more specific and detailed evaluation of adequate sedation.
TRIAL REGISTRATION
This study is registered at ClinicalTrials.gov since January 22, 2021, registration number: NCT04719702.
背景
姑息性镇静是指对患有危及生命疾病且遭受难治性痛苦的患者，有意按比例降低其意识水平。需要监测姑息性镇静的效果以确保患者舒适。本研究的目的是结合不适水平与镇静/躁动水平来评估其效果。
方法
在这项前瞻性观察研究中，从五个欧洲国家的临终关怀病房、姑息治疗病房和医院病房招募成年晚期恶性肿瘤患者。医护人员通过代理观察不适水平（阿尔茨海默病型痴呆不适量表，范围0 - 27）和镇静/躁动水平（针对姑息治疗住院患者修改的里士满躁动 - 镇静量表，范围 - 5至 + 4）来评估姑息性镇静的效果。
结果
78名参与者在姑息性镇静期间接受了不适水平监测。镇静开始前的平均不适评分为9.4分（95%可信区间8.3 - 10.5），在整个镇静期间开始镇静后显著降低了6.0分（95%可信区间4.8 - 7.1）。在多变量分析中，未发现影响基线不适水平的显著因素。发现不适和镇静深度评分呈正相关，r为0.72（95%可信区间0.61 - 0.82）。不适量表的内部一致性良好（0.83），但“呼吸嘈杂”项目对总不适评分的信息量较少。
结论
可通过结合测量不适水平与镇静/躁动水平来评估姑息性镇静的效果。测量不适水平可能会对充分镇静提供更具体和详细的评估。
试验注册
本研究自2021年1月22日起在ClinicalTrials.gov注册，注册号：NCT04719702。
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