■姑息治疗对于终末期肝病(ESLD)患者通常是次优的。腹水仍然是ESLD中最常见的并发症。尽管长期腹腔引流(LTAD)通常用于难治性恶性腹水,ESLD的标准治疗是医院引流(大体积穿刺(LVP)).正在进行的美国国立卫生与护理研究所(NIHR)资助的试验(REDUCe2研究)(ISRCTN269936824)将姑息性LTAD与ESLD中的LVP进行比较。这个35个地点的试验是在英国进行的,苏格兰和威尔士。
■了解医疗保健专业人员(HCP)对在ESLD中使用姑息性LTAD的看法和经验。
■在2019年8月至12月之间使用了一项电子调查,该调查包括七个带有固定定量选项的问题和三个探索性问题。该调查通过英国肝脏研究协会通讯以电子方式分发,并分发到英格兰东南部和伦敦东北部的相关医院部门。在初次邀请调查后的4周和8周发送了电子邮件提醒。
■有211名受访者(肝病专家(36.5%),专科护士(24.6%),胃肠病学家(16.6%),学员(17%)和其他人(5.2%))。所有受访者都可以使用LVP,86%的患者接受经颈静脉肝内门体分流术,67%到LTAD,10%到其他选项,如自动低流量腹水(ALFA)泵。调查的大多数受访者(68%)报告了他们使用LTAD的经验。几乎所有受访者(91%)都愿意在ESLD中考虑LTAD。然而,这方面的主要威慑因素是感知到的感染风险(90%),其次是社区的LTAD管理(57%)。有使用LTAD经验的患者中约有51%报告了患者的临床并发症(包括出血,感染和肾功能损害),41%的人报告了技术问题,35%的人报告了社区支持不足。
■由于ESLD,几乎所有的HCP都愿意在难治性腹水中考虑姑息性LTAD,但主要的威慑因素是感知到的感染风险和缺乏指导社区管理的公开数据。REDUCe2审判将澄清这些担忧是否真实,并提供关于角色的确凿证据,如果有的话,在这个脆弱的和正在研究的ELD队列中,姑息性LTAD。
UNASSIGNED: Palliative care is often suboptimal for patients with end-stage liver disease (ESLD). Ascites remains the most common complication in ESLD. Though long-term abdominal drains (LTAD) are commonly used in refractory malignant ascites, the standard care for ESLD is hospital drainage (large volume
paracentesis (LVP)). There is an ongoing National Institute for Health and Care Research (NIHR) funded trial (REDUCe 2 Study) (ISRCTN269936824) comparing palliative LTAD to LVP in ESLD. This 35-site trial is being conducted in England, Scotland and Wales.
UNASSIGNED: To understand the views and experience of healthcare professionals (HCP) on the use of palliative LTAD in ESLD.
UNASSIGNED: An electronic survey comprised of seven questions with fixed quantitative options and three exploratory questions was used between August-December 2019. The survey was distributed electronically via the British Association for Study of Liver newsletter and to relevant hospital departments in Southeast England and Northeast London. An email reminder was sent at 4 and 8 weeks after the initial invitation to the survey.
UNASSIGNED: There were 211 respondents (hepatologists (36.5%), specialist nurses (24.6%), gastroenterologists (16.6%), trainees (17%) and others (5.2%)). All respondents had access to LVP, 86% to a transjugular intrahepatic portosystemic shunt procedure for patients, 67% to LTADs and 10% to other options, such as the automated low-flow ascites (ALFA) pump. The majority of respondents to the survey (68%) reported their experience of using LTAD. Almost all respondents (91%) were willing to consider LTAD in ESLD. However, the main deterrents of this were the perceived risk of infection (90%), followed by LTAD management in community (57%). Some 51% of those with prior experience of using LTAD reported clinical complications for patients (including bleeding, infection and renal impairment), 41% reported technical issues and 35% inadequate community support.
UNASSIGNED: Almost all HCPs are willing to consider palliative LTAD in refractory ascites due to ESLD, but the main deterrents are the perceived infection risk and lack of published data to guide community management. The REDUCe 2 trial will clarify if these concerns are real and provide conclusive evidence on role, if any, of palliative LTADs in this vulnerable and under researched cohort with ESLD.