有關癌末病人難治之症狀使用緩和鎮靜的議題

The Issue about Palliative Sedation for Refractory Symptoms in Patients with Terminally Ill Cancer

高以信(Yee-Hsin Kao) ； 陳世琦(Shi-Chi Chen) ； 江瑞坤(Jui-Kun Chiang) ； 林小琪(Hsiao-Chi Lin)

《安寧療護雜誌》 15卷3期 (2010/11) Pp. 319-330

https://doi.org/10.6537/TJHPC.2010.15(3).4

摘要

癌末病人常面臨許多嚴重的症狀。大多數病人的這些症狀在醫療人員的用心治療後都能得到緩解。然而有少部分的病人，其症狀仍無法緩解。這些無法緩解的症狀是指經過多科專業人員的努力，但是治療的過程不能影響病人的意識，而其症狀仍無法緩解才稱爲難治的症狀。難治症狀的定義，依據Cerny等的定義爲在所有可能的治療都使用過仍無法改善的症狀，或是評估病人在可以忍受的時限與風險效益比的範疇內，並無方法可以緩解病人的症狀。難治的症狀之原因有生理的及心理靈性的。由於這些難治的症狀會對病人的生活品質帶來負面的效應，且此症狀在病人臨終時發生的機率會增加，以及影響病人瀕死的過程。因此，緩和鎮靜是當病人面臨此情境時，醫療人員可提供的最後一線治療方式。緩和鎮靜的定義是使用會降低病人的意識的鎮靜藥物，來達成緩解病人無法忍受、難治之痛苦爲目的。

關鍵字

緩和鎮靜 ； 難治的症狀 ； 癌末

並列摘要

Patients with terminally ill cancers are often confronted with several severe symptoms during the last phase of their lives. In the majority of patients, these symptoms can be well controlled. However, in some patients, some symptoms remain uncontrolled or refractory symptoms. Refractory symptoms are the symptoms persisted suffering the patients despite efforts of interdisciplinary team, and they cannot be adequately treated without compromising the consciousness of the patient.
The definition of refractory symptoms by Cherny is symptoms for which all possible treatment has failed, or it is estimated that no methods are available for palliation within the time frame and the risk-benefit ratio that the patient can tolerate. These refractory symptoms may be physical or psycho-existential origin. Refractory symptoms have a major negative effect on patient quality of life, often increase as the patients near the end of life, and interfere with a peaceful dying process. Palliative sedation has been proposed as one of the options of the last resort when patients are confronted with refractory symptoms. Palliative sedation is defined as the use of specific sedative medications to relieve intolerable suffering from refractory symptoms by a reduction in patient's consciousness, using appropriate drugs carefully titrated to the cessation of symptoms.

並列關鍵字

palliative sedation ； refractory symptom ； terminally ill cancer