肺癌末期病人使用高流量氧氣鼻導管之安寧療護經驗：一個案報告

Experience with the Use of a High-Flow Nasal Cannula in Hospice Care for a Terminal Lung Cancer Patient: A Case Report

歐明蓉(Ming-Jung Ou) ； 陳佳純(Chia-Chun Chen) ； 陳虹錚(Hung-Cheng Chen) ； 李純瑩(Chun-Ying Li) ； 吳建誼(Chien-Yi Wu)

《安寧療護雜誌》 23卷2期 (2019/06) Pp. 168-177

https://doi.org/10.6537/TJHPC.201906_23(2).05

摘要

肺癌末期病人常會出現呼吸喘的症狀，除了病人的不適外，對於家屬也是一種精神上的折磨。藥物使用（包括嗎啡類）為目前主要治療方式，而氧氣供應則做為輔助治療。然而傳統氧氣供應設備，長期使用易出現副作用。目前新興的高流量氧氣鼻導管（High flow nasal cannula），能提供足夠氧氣濃度，同時增加舒適度。本文個案，於生命末期階段為呼吸喘所苦。使用傳統氧氣供應、類固醇、嗎啡及鎮靜劑後，症狀雖改善，但出現面部壓瘡及口腔潰瘍等問題。安寧團隊嘗試使用高流量氧氣鼻導管，使用後，除了降低前述副作用，也使呼吸喘更為改善。依據此個案照護經驗，高流量氧氣鼻導管或許可作為肺癌末期安寧病人氧氣供應的選擇之一。

關鍵字

安寧療護 ； 肺癌末期 ； 呼吸喘 ； 高流量氧氣鼻導管

並列摘要

The prevalence of dyspnea in terminal lung cancer patients is high. Dyspnea not only contributes to patient discomfort, but also causes psychological distress to the families of the affected patients. Opioids constitute the major treatment approach for dyspnea, while oxygen therapy is an adjunctive modality. The traditional oxygen therapy devices have multiple limitations and side effects. High-flow nasal cannula oxygen therapy presents a new alternative to conventional oxygen therapy as it provides sufficient oxygenation and is associated with better tolerance. In our case, the patient had terminal lung cancer and developed dyspnea in his end-of-life period. His symptoms improved with traditional oxygen therapy and use of morphine, corticosteroid, and benzodiazepines, but he developed facial and oral ulcers. Therefore, our hospice team started high-flow nasal cannula therapy. This treatment minimized the side effects of traditional oxygen therapy and improved dyspnea. Our findings in this case indicate that the use of a high-flow nasal cannula could be considered an option for oxygen therapy in patients with terminal lung cancer.

並列關鍵字

hospice care ； terminal lung cancer ； dyspnea ； high-flow nasal cannula

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