背景:姑息性镇静是有意识地降低患者的意识以缓解难治性症状。然而,关于儿童姑息镇静的研究很少。我们旨在调查使用镇静疗法的儿童在生命末期的症状控制和风险。
方法:本研究为单中心回顾性队列研究。将姑息内科死亡患儿分为姑息镇静组(A组)和非姑息镇静组(B组)。症状缓解,生存时间,比较两组患者末次住院时间。
结果:从2012年1月至2019年11月,41名儿童在姑息治疗部门死亡。24名儿童被镇静(A组),同时17名儿童没有(B组)。A组的症状比B组更复杂(p=0.013)。A组的总体症状缓解高于B组(24/24,10/15p=0.041)。疼痛缓解率(7/7,20/21p=0.714),最大/死亡前阿片类药物剂量[30(20,77.5),18(9,45)p=0.175,30(20,60),18(9,45)p=0.208]和疼痛强度差[5(4,6.5),4(2,6)p=0.315]在两组中都没有显着差异。诊断后,A组的生存时间长于B组(p=0.047)。然而,两组患者死亡前的住院时间相似(p=0.385).
结论:姑息镇静控制复杂,在生命结束时出现疼痛症状,并且不会缩短儿童的住院时间。
BACKGROUND: Palliative sedation is consciously reducing the patient\'s consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life.
METHODS: This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups.
RESULTS: From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p = 0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p = 0.041). Pain relief rates (7/7, 20/21 p = 0.714), maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p = 0.175, 30(20, 60), 18(9, 45) p = 0.208] and pain intensity difference [5(4,6.5), 4(2,6) p = 0.315] did not differ significantly in either groups. After diagnosis, the survival time of the Group A was longer than the Group B (p = 0.047). However, the length of hospitalization before death was similar in two groups (p = 0.385).
CONCLUSIONS: Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.