瀕死病患的喘

Dyspnea in Terminally Ill Patients

陳亮恭(Liang-Kung Chen) ； 蔡世滋(Shih-Tzu Tsail) ； 林明慧(Ming-Huei Lin) ； 吳彬源(Bin-Yuan Wu) ； 陳振文(Tzen-Wen Chen) ； 黃信彰(Shinn-Jang Hwang)

《安寧療護雜誌》 6卷4期 (2001/11) Pp. 34-40

https://doi.org/10.6537/TJHPC.2001.6(4).5

摘要

在所有的末期癌症病人身上，不論癌症的種類，約有50%會出現喘的症狀，在肺癌病人中更高達70%，而在病人死亡前的一周，喘常常會是病患相當難過且難以解決的困擾。從緩和醫療的角度來看，我們處理病患的喘時要注意四點：(1)已知存在的疾病(2)急性呼吸系統併發症(3)直接與癌症相關的問題(4)因癌症治療所致的疾病等等。
不論是否從緩和醫療的角度出發，治療喘的原則基本上並沒有什麼不同，就是先找出病患是否有任何引起喘的原因，並針對病因給予適當的藥物。臨床上使用嗎啡來緩解喘的症狀聽來匪夷所思，但是實際上確有其療效，截至目前為止，嗎啡止喘的作用機轉依然未有定論。
嗎啡在緩和醫療的領域有著很廣泛的使用，除了止痛之外，對緩解病人的喘更有明顯的療效。臨床醫護人員對於使用嗎啡類藥物治療病患的喘有著很多的疑慮，雖然已有許多的報告指出嗎啡治療的安全性與療效，但是卻依然令部分醫護人員猶豫不決。嗎啡的療效並非只在癌症病人，連嚴重的阻塞性肺疾病與心臟衰竭都有正面的治療效果，當現有的醫療處置不足以為病患解決其疾病時，病患有得到症狀的緩解的權利，所以在一些末期疾病病人喘的治療上，嗎啡的角色可能會與日俱增。

關鍵字

喘 ； 嗎啡 ； 癌症 ； 安寧療護

並列摘要

Regardless of cancer biology, dyspnea would occur in 50% of terminal cancer patients. In patients with lung cancer, about 70% of patients in terminal stage would experience dyspnea. Dyspnea is difficult to resolve in terminally ill patients and usually leads to sufferings. From the viewpoint of Palliative Medicine, the management of terminal dyspnea should be consider (1) the existing underlying diseases, such anemia (2) acute respiratory complications, such a s pneumonia (3) specific cancer-associated problems, such as malignant pleural effusion (4) complications related to cancer treatment, such as radiation pneumonitis.
In the management of dyspnea, the underlying diseases should always be treated first. However, in terminal patients, palliation of discomfort may be more important than curative treatment. Therefore, to palliative the suffering from dyspnea is crucial to care terminal cancer patients. Morphine is clinically effective to relieve the distress of dyspnea although the mechanism remains unclear. The clinical use of morphine in the management of dyspnea in terminal patients is relatively common, but is not well accepted in other specialties. Morphine had been documented being effective to relieve the dyspnea in congestive heart failure and chronic obstructive pulmonary disease. Physicians should use every effort to relieve the sufferings of terminally ill patients when the underlying condition is not curable. Therefore, the clinical use of morphine in terminal patients will become more and more important.

並列關鍵字

Dyspnea ； hospices ； morphine ； neoplasm ； terminal care