Randomized Double-Blind Trial of Sublingual Atropine vs. Placebo for the Management of Death Rattle
Randomized Double-Blind Trial of Sublingual Atropine vs. Placebo for the Management of Death Rattle
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DOI：
10.1016/j.jpainsymman.2012.01.006
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发表时间：
2013-01-01
影响因子：
4.7
通讯作者：
Gerkin, Richard
中科院分区：
文献类型：
--
作者：
Heisler, Mark;Hamilton, Gillian;Gerkin, Richard
上下文。由呼吸道分泌物（RTS）引起的嘈杂呼吸，通常被称为“死亡嘎嘎声”，发生在多达一半的垂死病人身上。尽管缺乏证据表明与安慰剂相比，抗uscarinic药物有好处，但它已被用于减少与RTS相关的噪音和减少家庭痛苦。本研究的目的是比较抗毒蕈碱药物阿托品与安慰剂在减少死亡响尾音相关噪音方面的疗效。终末期成人安宁疗护住院病人因RTS而出现呼吸噪音，随机分为双盲治疗组，分别使用阿托品或安慰剂。研究药物以单次舌下剂量给药。在基线、2小时和4小时监测呼吸噪音。137名参与者被随机分配到阿托品或安慰剂组。服用阿托品和安慰剂的受试者中，噪声评分从基线到给药后2小时的降低率分别为37.8%和41.3% （P = 0.73）。使用阿托品和安慰剂的受试者在4小时时噪音评分降低的比例分别为39.7%和51.7% （P = 0.21）。两组间在任何时间点的差异均不显著。阿托品耐受性良好。两组患者心率均略有增加（阿托品组+1.1/分钟，安慰剂组+3.1/分钟），但无显著性差异。单剂量给予舌下阿托品在减少与死亡震动相关的噪音方面并不比安慰剂更有效。[J] journal of practical nursing; 2013;45(5): 391 - 391。(C) 2013年美国癌症疼痛缓解委员会。Elsevier Inc.出版。版权所有。
Context. Noisy breathing because of respiratory tract secretions (RTS), often referred to as "death rattle," occurs in up to half of all dying patients. Despite a lack of evidence showing benefit compared with placebo, antimuscarinic medications have been used in an attempt to decrease noise associated with RTS and to decrease family distress.Objectives. The goal of this study was to compare the efficacy of the antimuscarinic medication atropine with that of placebo in reducing noise associated with death rattle.Methods. Terminally ill adult hospice inpatients who developed noisy breathing as a result of RTS were randomized to double-blind treatment with atropine or placebo. Study drug was given as a single sublingual dose. Noise from breathing was monitored at baseline and at two and four hours.Results. One hundred thirty-seven participants were randomized to atropine or placebo. Reduction in noise score from baseline to two hours after dose occurred in 37.8% and 41.3% of subjects treated with atropine and placebo, respectively (P = 0.73). Noise score reduction at four hours occurred in 39.7% and 51.7% of subjects treated with atropine and placebo, respectively (P = 0.21). Differences between groups were not significant at either time point. Atropine was well tolerated. Heart rate increased slightly in both groups (+1.1/minute for atropine and +3.1/minute for placebo) but not significantly.Conclusion. Sublingual atropine given as a single dose was not more effective than placebo in reducing the noise associated with death rattle. J Pain Symptom Manage 2013;45:14e22. (C) 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.