Aulbert E
Abteilung f. Innere Medizin, Evang. Waldkrankenhaus Spandau, Berlin.
Zentralbl Chir. 1998;123(6):632-6.
Palliative care is the active total care of patients whose disease is not or no more responsive to curative treatment. Its action strategies should be applied at the time when the goals change from cure to care. Palliative care is total care of body, mind and spirit. Control of pain, of other symptoms and of psychosocial, social and spiritual problems, is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families. Psychosocial support plays a vital role in the assessment and treatment of anxiety and depression in patients with advanced illness. Appropriate intervention of psychosocial distress in patients and families can ease the family bereavement period. It can also decrease occupational stress and burnout in the professional caregivers. One of the principal functions of palliative care is the prevention and control of distressing symptoms. Freeing sick people, emancipating them from pain and unendurable symptoms is one of the conditions that sick and dying people need most. This allows them to live their remaining time as fully as possible. The general principles of treating dyspnoea and pain are the same as for any other aspect of treatment in palliative care: 1. to define and treat the underlying cause of dyspnoea wherever possible and reasonable for the patient. This includes oncological interventions such as chemotherapy and radiotherapy as far as the patient's status allows it. 2. to relieve dyspnoea without adding new problems by way of sideeffects, interactive effects, social or financial burdens. The rule of proportionality to treatment affirms that symptom control and life-prolonging treatment are contraindicated when they cause more suffering than benefit. 3. to consider whether a treatment will be worthwhile for the patient and his family bearing in mind his prognosis and adverse effects of invasive procedures. 4. to discuss all reasonable treatment options (including the decision of "no intervention") with the patient and his family, allowing them to make the final decision as far as possible by themselves.
姑息治疗是针对疾病无法治愈或对治愈性治疗不再有反应的患者所提供的积极全面护理。当治疗目标从治愈转变为护理时，就应实施其行动策略。姑息治疗是对患者身体、心理和精神的全面护理。控制疼痛、其他症状以及心理社会、社会和精神问题至关重要。姑息治疗的目标是为患者及其家人实现最佳生活质量。心理社会支持在晚期疾病患者焦虑和抑郁的评估与治疗中起着至关重要的作用。对患者及其家人的心理社会困扰进行适当干预，可以缓解家庭丧亲期的痛苦。这也可以减轻专业护理人员的职业压力和倦怠感。姑息治疗的主要功能之一是预防和控制令人痛苦的症状。使患者摆脱病痛，将他们从疼痛和无法忍受的症状中解脱出来，是患病和临终患者最需要的条件之一。这能让他们尽可能充实地度过余生。治疗呼吸困难和疼痛的一般原则与姑息治疗中其他任何治疗方面相同：1. 尽可能且在对患者合理的情况下确定并治疗呼吸困难的根本原因。这包括只要患者状况允许，就进行诸如化疗和放疗等肿瘤学干预措施。2. 缓解呼吸困难时，避免因副作用、相互作用、社会或经济负担而产生新问题。治疗相称性原则表明，当症状控制和延长生命的治疗造成的痛苦超过益处时，不应采用。3. 考虑某种治疗对患者及其家人是否值得，要牢记其预后以及侵入性操作的不良反应。4. 与患者及其家人讨论所有合理的治疗选择（包括“不干预”的决定），尽可能让他们自己做出最终决定。
