End-of-life care in cystic fibrosis
End-of-life care in cystic fibrosis
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DOI：
10.1542/peds.100.2.205
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发表时间：
1997-08-01
期刊：
影响因子：
8
通讯作者：
Wohl, ME
中科院分区：
文献类型：
--
作者：
Robinson, WM;Ravilly, S;Wohl, ME
Objective.囊性纤维化（CF）的临终临床护理与儿童癌症的临终护理有很大不同。为了检验这种差异，我们回顾了在波士顿儿童医院接受治疗的CF患者队列的医疗护理，以记录死亡前一个月预防、治疗和姑息治疗的使用情况。本文回顾了1984 ~ 1993年44例5岁以上死于CF相关性呼吸衰竭的患者的临床资料。38例患者（86%）接受阿片类药物治疗重度呼吸困难和疼痛;阿片类药物使用的持续时间从不到1小时到超过1个月不等。鸦片剂的剂量从每小时不到5毫克到每小时超过30毫克不等。33名患者（75%）在生命的最后12小时内继续接受静脉注射抗生素; 32名（72%）在生命的最后12小时内继续接受预防性或治疗性口服药物。所有患者在死亡时均被指定为未复苏; 43例患者在医院死亡，1例患者在临终关怀下在家中死亡。结论.模型OL：在儿童慢跑时发展的舒适护理不能充分描述我们机构在CF生命结束时给予的预防、治疗和姑息治疗的组合。大多数CF患者继续接受静脉注射抗生素和/或口服维生素制剂，同时接受阿片类药物治疗终末疼痛和呼吸困难。小剂量的阿片类药物似乎是有效的治疗疼痛和呼吸困难在生命的尽头CF。
Objective. End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in childhood cancer. To examine this difference, we reviewed the medical care of a cohort of CF patients treated at Children's Hospital, Boston, to document the use of preventive, therapeutic, and palliative care in the month preceding death.Patients. We reviewed the medical records of 44 patients older than 5 years who died of CF-related respiratory failure for the years 1984 to 1993.Results. Thirty-eight patients (86%) received opiates for the treatment of severe dyspnea and pain; the duration of opiate use varied from less than 1 hour to greater than 1 month. The dose of opiates varied from less than 5 mg per hour to greater than 30 mg per hour. Thirty-three patients (75%) continued to receive intravenous antibiotics in the last 12 hours of life; 32 (72%) continued to receive preventive or therapeutic oral medications in the last 12 hours of life. All patients were designated as do not resuscitate at the time of death; 43 of the patients died in the hospital with I patient dying at home under hospice care. Conclusions. The model ol: comfort care developed in childhood canter does not adequately describe the combination of preventive, therapeutic, and palliative care given at the end of Life for CF at our institution. The majority of CF patients continued to receive intravenous antibiotics and/or oral vitamin preparations while being treated with opiates for terminal pain and dyspnea. Small doses of opiates seem to be effective in the treatment of the pain and dyspnea at the end of life in CF.