Hansen-Flaschen J
Pulmonary and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, USA.
Clin Chest Med. 1997 Sep;18(3):645-55. doi: 10.1016/s0272-5231(05)70407-x.
Considering that lung disease is the fourth leading cause of death in the United States, remarkably little has been written about palliative care for patients who die of respiratory disease. Because most such deaths are anticipated, palliative care should begin with advance medical planning, ideally in the form of a prescheduled meeting among the physician, the patient, and the patient's proxy for health affairs. Home hospice care should be considered when a patient with progressive lung disease is largely confined to the bedroom because of dyspnea. Medical attention during the terminal phase of a respiratory illness should focus on the experience of the patient. Common symptoms amenable to counseling and pharmacotherapy include dyspnea, pain, anxiety, insomnia, and depression. If initiated to no benefit, mechanical ventilation can be terminally withdrawn with the concurrence of the patient or family. The withdrawal process should be family centered, and followed by continued supportive care until the patient dies.
鉴于肺部疾病是美国第四大死因，令人惊讶的是，关于死于呼吸系统疾病患者的姑息治疗的著述却非常少。由于大多数此类死亡是可预见的，姑息治疗应从预先的医疗规划开始，理想的形式是医生、患者以及患者的健康事务代理人预先安排好会面。当患有进行性肺部疾病的患者因呼吸困难而大部分时间只能局限于卧室时，应考虑家庭临终关怀护理。呼吸系统疾病终末期的医疗护理应关注患者的体验。适合咨询和药物治疗的常见症状包括呼吸困难、疼痛、焦虑、失眠和抑郁。如果启动后没有益处，在患者或家属同意的情况下，可以在终末期撤除机械通气。撤除过程应以家庭为中心，并在其后持续提供支持性护理直至患者死亡。
