Mancini I, Body J J
Clinique des Soins Supportifs et des Soins Palliatifs, Institut J. Bordet, U.L.B.
Rev Med Brux. 1998 Sep;19(4):A327-31.
Patients with advanced cancer frequently present with chronic nausea, emesis, bowel obstruction, confusional syndromes or dysphagia. All these conditions make it difficult for the patient to take oral medications or to maintain an adequate level of hydration by mouth. Hypodermoclysis is a safe and simple method that allows for cost-effective sucutaneous delivery of fluids and drugs. Hypodermoclysis has some clearcut advantages over the i.v. route. It can be started without need for a physician or a nurse, does not immobilize a limb, can be stopped and restarted at any moment without concern for clotting, and its use sparses nursing time. It also allows for easier and safer home discharge. Potentiel side effects of hypodermoclysis include pain at infusion site, sloughing tissues as a result of insufficient fluid absorption, infection, and puncture of vessels with bleeding. This paper gives some guidelines for the use of hypodermoclysis for fluid, electrolytes and drugs frequently used in a palliative care setting. The controversy surrounding the treatment of dehydration in the terminally ili is also briefly examined.
晚期癌症患者常伴有慢性恶心、呕吐、肠梗阻、意识障碍综合征或吞咽困难。所有这些情况都使患者难以口服药物或通过口服维持足够的水合水平。皮下输液是一种安全、简单的方法，可实现经济高效的皮下液体和药物输送。皮下输液相对于静脉途径具有一些明显的优势。它无需医生或护士即可开始，不会使肢体固定，可随时停止和重新开始，无需担心凝血问题，且使用时可节省护理时间。它还使患者更容易、更安全地出院。皮下输液的潜在副作用包括输液部位疼痛、因液体吸收不足导致的组织坏死、感染以及血管穿刺出血。本文给出了在姑息治疗环境中皮下输液用于常用液体、电解质和药物的一些指导原则。还简要探讨了围绕晚期疾病患者脱水治疗的争议。
