晚期癌症的呼吸困难和咳嗽.pptVIP

晚期癌症的呼吸困难和咳嗽Dyspnea Cough:Advance Cancer Terence L. Gutgsell, MD Hospice of the Bluegrass Palliative Care Center of the Bluegrass October 2003 晚期癌症呼吸困难Dyspnea: Advance Cancer 呼吸困难：定义，发病率 Dyspnea: definition, prevalence 呼吸困难的原因 Causes of dyspnea 评估 Assessment 症状治疗 Symptomatic therapy 阿片类药物的作用 Role of opioids 呼吸困难：定义Dyspnea: Definition 呼吸困难的感知 Perception of difficulty breathing 主观体验 Subjective experience 无以下客观指征 Cannot be defined by 躯体异常，客观体征 Physical abnormality, objective sign 实验室诊断依据 Diagnostic test 症状的严重程度与可测定的异常之间并无联系 No correlation between symptom severity and measurable abnormality 呼吸困难的变异性Dyspnea Variability 广泛的变异 Wide variation: 疾病间的变异 Variation between diseases 个体间的变异 Variation between individuals 由先前的体验形成 Shaped by previous experience 多因素调节感知的性质和强度 Many factors modulate quality and intensity of perception Dudgeon et al. J Pain Symptom Management. 1998; 11(4): 212-219. 呼吸困难的要素Components of Dyspnea 呼吸困难：全国姑息关怀调查Dyspnea: National Hospice Study 全国范围内的预期数据收集 National prospective data collection effort 40家姑息关怀中心和14家非姑息关怀病房 40 hospices and 14 non-hospice care settings 1754名预后小于6个月的癌症患者 1754 cancer patients with prognosis 6 months 对症状进行两周一次的检查 Biweekly interview on symptoms 70%的患者在生命的最后6周里有呼吸困难 70% had dyspnea during the last 6 weeks of life Reuben et al. Chest. 1986; 89: 234-236. 呼吸困难：全国姑息关怀中心调查Dyspnea: National Hospice Study 其发病率仅次于疼痛和吞咽困难 Prevalence exceeded only by pain and eating difficulties 随着病人临近死亡呼吸困难的发病率增加 Prevalence rates increased as patients approached death 呼吸困难最重要的预测指征 Most important predictor of dyspnea 1754名癌症患者中有39%具有肺部和胸膜的癌性浸润 39% of the 1754 cancer patients had lung or pleural involvement of cancer Reuben et al. Chest. 1986; 89: 234-236. 呼吸困难：全国姑息关怀中心调查Dyspnea: National Hospice Study 与肿瘤无关的呼吸困难 Dyspnea not related to tumor 心脏疾病占34% Cardiac disease 34% 慢性肺部疾患占 24%Chronic pulmonary disease 24% 24%的患者的呼吸困难可仅由衰竭引起