Ashino Y, Muto A, Kanno A, Ito H, Moriyama A, Hiraga M
Dept. of Surgery, Fukushima Rousai Hospital.
Gan To Kagaku Ryoho. 1996 Dec;23 Suppl 3:297-303.
We reported the kind of symptoms and how they could be palliated in terminally ill patients at home based on our experience of about 9 years. Cancer pain, which was the most frequent symptom, appeared in 67 among 126 patients receiving home care, and it could be effectively controlled with morphine; no patient returned to the hospital because of aggravation of pain. Very few patients stayed in the hospital and never returned home due to uncontrollable pain. Home parenteral infusion was done for 63 patients who were unable to eat or drink because of peritonitis carcinomatosa or cancer cachexia. High fever in the tumor mass was controlled by glucocorticoid hormone, and ascites was drained continuously when the patients suffered from abdominal distension. From analysis of the cases in which home care was interrupted or those in which patients were unable to transfer to home care, symptoms that were difficult to palliate at home were nausea caused by bowel obstruction, acute symptoms (bleeding, disturbance of consciousness, and so on), and dyspnea. But if the patients and family are eager for home care and an adequate medical support system is in place, home care may be possible despite these symptoms.
基于我们约9年的经验，我们报告了在家中晚期患者身上出现的症状类型以及如何缓解这些症状。癌痛是最常见的症状，在126例接受居家护理的患者中，有67例出现癌痛，使用吗啡可有效控制；没有患者因疼痛加剧而返回医院。因疼痛无法控制而住院且再也没有回家的患者极少。63例因癌性腹膜炎或癌症恶病质而无法进食或饮水的患者接受了家庭胃肠外营养支持。肿瘤块的高热用糖皮质激素控制，患者出现腹胀时持续引流腹水。通过对居家护理中断的病例或患者无法转为居家护理的病例进行分析，在家中难以缓解的症状是肠梗阻引起的恶心、急性症状（出血、意识障碍等）和呼吸困难。但是，如果患者和家属渴望居家护理且有适当的医疗支持系统，尽管有这些症状，居家护理仍有可能实现。
