Palliative care for patients with end-stage liver disease.
Palliative care for patients with end-stage liver disease.
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DOI：
10.1007/s11894-015-0440-6
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发表时间：
2015-05-01
影响因子：
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通讯作者：
Larson, Anne M
中科院分区：
文献类型：
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作者：
Larson, Anne M
在美国，肝病每年导致超过 400 万人次就诊和超过 75 万人次住院。慢性肝病患者经常进展为肝硬化、终末期肝病 (ESLD) 和死亡。 ESLD 患者会出现多种并发症，包括肌肉痉挛、精神错乱（肝性脑病）、蛋白质热量营养不良、肌肉萎缩、液体超负荷（腹水、水肿）、出血（食管胃静脉曲张出血）、感染（自发性细菌性腹膜炎）、疲劳、焦虑和抑郁。尽管这些并发症的缓解效果显着改善，但患者的生活质量仍然下降，并且必须面对这样的事实：他们的疾病往往会无情地进展至死亡。在这种情况下，肝移植是一种有效的选择，可以延长生存时间并减轻许多症状。然而，许多患者在等待器官时死亡，或者由于合并症而不是移植的候选者。其他人接受移植但死于移植本身的并发症。患者和家属必须在面临危及生命的疾病的同时，一边希望治愈，一边努力奋斗。理想情况下，姑息治疗与维持生命治疗相结合可以最大限度地提高患者的生活质量和数量。如果生命维持治疗显然不再是一种选择，那么这些患者就已经进入了一个帮助他们进行临终关怀的系统中。
Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression. Despite significant improvements in palliation of these complications, patients still suffer reduced quality of life and must confront the fact that their disease will often inexorably progress to death. Liver transplantation is a valid option in this setting, increasing the duration of survival and palliating many of the symptoms. However, many patients die waiting for an organ or are not candidates for transplantation due to comorbid illness. Others receive a transplant but succumb to complications of the transplant itself. Patients and families must struggle with simultaneously hoping for a cure while facing a life-threatening illness. Ideally, the combination of palliative care with life-sustaining therapy can maximize the patients' quality and quantity of life. If it becomes clear that life-sustaining therapy is no longer an option, these patients are then already in a system to help them with end-of-life care.