Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later
Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later
复制标题
DOI：
10.1016/j.jpainsymman.2018.08.018
复制
发表时间：
2018-12-01
影响因子：
4.7
通讯作者：
Aielli, Federica
中科院分区：
文献类型：
--
作者：
Mercadante, Sebastiano;Marinangeli, Franco;Aielli, Federica
上下文临终前的啰音（DR）是临终病人的一个戏剧性的体征。抗胆碱能药物的现有研究存在争议，因为这类药物通常在不考虑作用机制的基础上给药。有意义地使用这些药物可能会提供更好的结果。本研究的目的是评估丁溴东莨菪碱（HB）的疗效，与一旦发生DR时给予HB相比，采用药物治疗。在里士满焦虑-镇静量表姑息版中得分>= 3的垂死患者被纳入研究。HB（60 mg/d）在DR发生时（组1）或作为预防性治疗（组2）给予。每隔一段时间记录DR的出现时间（无死亡震颤时间）和DR的强度，直至死亡。分别将81例和51例患者随机分配至第1组和第2组。第2组患者生存时间明显长于第1组（P < 0.05）。第1组和第2组分别有49例（60.5%）和3例（5.9%）患者发生DR（P = 0.001）。在检查的时间间隔（30分钟、1小时、然后每6小时直至死亡[P = 0.001]）发现报告DR的患者数量存在显著差异。在第1组和第2组中，无DR时间分别为20.4（20.5）和27.3小时（25.2）（P = 0.001）。在第1组中，仅10例（20.4%）患者在平均14.4小时（SD 8.57）后认为治疗有效。预防性使用HB是预防DR的有效方法，而晚期给药产生有限的反应，证实了传统抗胆碱能药物研究的数据。这可以被认为是管理困难和戏剧性标志的新范例，例如DR.（C）2018美国临终关怀和姑息医学学院。爱思唯尔公司出版All rights reserved.
Context. Death rattle (DR) is a dramatic sign in the dying patient. Existing studies with anticholinergic agents are controversial, as this class of drugs has been commonly administered without considering the rationale of the mechanism of action. A meaningful use of these drugs may provide a better outcome.Objectives. The aim of this study was to assess the efficacy of hyoscine butylbromide (HB), given prophylactically in comparison with HB administered once DR occurs.Methods. Dying patients having a score of >= 3 in the Richmond Agitation-Sedation Scaledpalliative version were included in the study. HB (60 mg/day) was given when DR occurred (Group 1) or as pre-emptive treatment (Group 2). The onset of DR (death rattle free time) and intensity of DR were recorded at intervals until death.Results. Eighty-one and 51 patients were randomized to Group 1 and 2, respectively. Patients in Group 2 survived longer than those in Group 1 (P < 0.05). DR occurred in 49 (60.5%) and three patients (5.9%) in Group 1 and 2, respectively (P = 0.001). A significant difference in the number of patients reporting DR was found at intervals examined (30 minutes, one hour, and then every six hours until death [P = 0.001]). In Group 1 and 2, DR free time was 20.4 (20.5) and 27.3 hours (25.2), respectively (P = 0.001). In Group 1, the treatment was considered effective in 10 patients (20.4%) only, after a mean of 14.4 hours (SD 8.57).Conclusion. The prophylactic use of HB is an efficient method to prevent DR, whereas the late administration produces a limited response, confirming data from traditional studies performed with anticholinergics. This could be considered a new paradigm to manage a difficult and dramatic sign, such as DR. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.