Should Benzodiazepines be Used for Reducing Dyspnea in Patients with Advanced Illnesses?
Should Benzodiazepines be Used for Reducing Dyspnea in Patients with Advanced Illnesses?
复制标题
是否应该使用苯二氮卓类药物来减轻晚期疾病患者的呼吸困难？
DOI：
10.1016/j.jpainsymman.2022.11.018
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发表时间：
2023
影响因子：
4.7
通讯作者：
Hui David
中科院分区：
文献类型：
--
作者：
Simon Steffen T.;Mori Masanori;Ekstr?m Magnus;Pralong Anne;Yamaguchi Takashi;Hui David
呼吸困难是一种常见的和高度痛苦的症状，在病人的晚期疾病。尽管对基础疾病进行了最佳管理并进行了各种非药物干预，但许多患者仍持续发生慢性呼吸困难，因此需要考虑使用药物治疗来缓解呼吸困难。临床医生经常问的一个问题是苯二氮卓类药物是否在缓解呼吸困难方面发挥作用。在这篇“姑息治疗的争议”文章中，三组思想领袖独立回答了这个问题。具体来说，每个小组都提供了关键研究的概要，这些研究为他们的思维过程提供了信息，分享了关于他们临床方法的实用建议，并强调了未来研究的机会。根据现有数据，所有三个研究组都表明，苯二氮卓类药物单独使用对晚期疾病的呼吸困难没有益处。他们还表达了对潜在不良反应（如谵妄和嗜睡）的担忧，并建议不要将苯二氮卓类药物作为一线药物治疗。一些研究小组认为，苯二氮卓类药物可用于高度选择的严重焦虑伴呼吸困难的患者。一些研究者也可能考虑在使用阿片类药物仍有严重呼吸困难的患者中连续使用苯二氮卓类药物，特别是如果预期寿命有限。苯二氮卓类药物在生命的最后几天对难治性呼吸困难也有姑息性镇静作用。需要更多的研究来证实苯二氮卓类药物在这些人群中的益处。
Dyspnea is a common and highly distressing symptom in patients with advanced illnesses. Many patients continue to experience chronic dyspnea despite optimal management of underlying disease(s) and various non-pharmacologic interventions, necessitating the consideration of pharmacologic therapies for palliation of dyspnea. One commonly asked question by clinicians is whether benzodiazepines have a role in the palliation of dyspnea. In this “Controversies in Palliative Care” article, three groups of thought leaders independently answer this question. Specifically, each group provides a synopsis of the key studies that inform their thought processes, share practical advice on their clinical approach, and highlight the opportunities for future research. All three groups suggest that benzodiazepines alone do not confer a benefit for dyspnea in advanced illnesses based on existing data. They also expressed concerns about the potential adverse effects such as delirium and drowsiness and recommended against benzodiazepines as first line pharmacologic therapy. Some groups suggest that benzodiazepines may be used in highly selected patients with severe anxiety associated with dyspnea. Some investigators may also consider the adjunctive use of benzodiazepines in patients with severe dyspnea despite opioids, particularly if life expectancy is limited. Benzodiazepines also have a role in palliative sedation for refractory dyspnea in the last days of life. More research is needed to confirm the benefit of benzodiazepines in these populations.