Abstract：
Context: Pain and symptom management at the end of life (EoL) can pose unique challenges, particularly when symptoms are refractory to conventional methods. Dexmedetomidine, originally approved for sedation in ventilated patients, has been demonstrated to be beneficial in pain management and palliative care settings by functioning as an alpha-2 agonist. Methods: A retrospective review of inpatient palliative care unit (IPU) records from January 2020 to December 2023 was conducted. Twenty-five adult patients receiving continuous dexmedetomidine for refractory pain at the EoL were identified. These patients were further evaluated for concurrent opioid, benzodiazepine, and chlorpromazine usage. Results: Patients experienced predominantly cancer-related pain, and had a median infusion duration of 5 days. Dexmedetomidine\'s initial dosing differed between the intensive care unit (ICU) and IPU settings. There was a trend toward a decreased opioid requirement 24 hours after initiation. Patients transferred from the ICU showed a progressive increase in opioid use. Conclusion: This study contributes to understanding dexmedetomidine\'s role in managing refractory symptoms at the EoL in the palliative care setting.
摘要：
背景：生命终结时的疼痛和症状管理（EoL）可能会带来独特的挑战，特别是当症状难以用常规方法治疗时。右美托咪定,最初被批准用于通气患者的镇静，已被证明通过作为α-2激动剂在疼痛管理和姑息治疗环境中是有益的。方法：对2020年1月至2023年12月的住院姑息治疗单位（IPU）记录进行回顾性审查。确定了25例接受持续右美托咪定治疗EoL难治性疼痛的成年患者。这些患者进一步评估并发阿片类药物，苯二氮卓,和氯丙嗪的使用。结果：患者主要经历癌症相关的疼痛，中位输注时间为5天。右美托咪定的初始剂量在重症监护病房(ICU)和IPU设置之间不同。开始后24小时，阿片类药物的需求量有降低的趋势。从ICU转移的患者显示阿片类药物的使用逐渐增加。结论：本研究有助于了解右美托咪定在姑息治疗环境中EoL治疗难治性症状的作用。
