Cancer：癌症病人垂死的八个迹象

佰通生物

原文地址连接：Cancer：癌症病人垂死的八个迹象   更多精彩新闻请点击：佰通生物

      得克萨斯大学Anderson Cancer Center的研究人员近日确认了8项将在3天内死亡的癌症病人相关的具体身体和认知迹象。可以帮助临床医生与患者以及家属沟通，引导医疗和护理人员的检查，治疗，停药，出院或者转诊相关决策。这项研究成果发表在近期Cancer杂志。
      以往临终护理研究重点主要是医生如何更好地观测。但是，根据研究小组领导人David教授的说法，如何判断一个病人已经进入生命的最后日子里的研究却比较少。实际上，可靠判断死神已经迫在眉睫可能对临床实践有显著影响。
      在过去，试图了解与垂死有关迹象的研究主要在已经被认定为快死亡的人群中进行，所以这个模型的潜在误差。而这项研究，从病人刚住进姑息治疗单位，在不知道患者会死亡或者出院的前提下，便开始观察病人体征，每日两次。
      研究人员进行了前瞻性研究，观察357例住进姑息治疗单位的癌症患者，其中57％患者最终死亡。研究人员在之前的系统研究中发现了52项身体和认知的迹象，随后确定了8种与3天内将死亡高度相关的表现。具体包括：瞳孔无反应；对言语刺激反应降低；视觉刺激反映降低； 眼皮无法关闭；鼻唇沟下垂；颈部过伸；声带咕哝声和上消化道出血。
      “当癌症患者达到生命的最后日子里，对于家庭这是一个非常情绪化的时间—他们承受了巨大的压力”研究人员Hui说，“知道什么时候死亡将至会提供更多的信息，以便照顾者可适当安排，对于临床医生，有这些信息可以帮助安抚家属，为患者提供最好最合适的治疗。”
      研究人员强调这项研究尚未实践，而且研究结果只代表即将因为癌症死亡的病例，不能推广到其他原因的死亡。
      研究的下一步会临床验证识别标志的可靠性，同时评估这项研究在其他国家是否一致和对于临终关怀设置的意义。

DOI: 10.1002/cncr.29048
Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study
David Hui MD, MSc, Renata dos Santos MD, Gary Chisholm MS, Swati Bansal MPH, Camila Souza Crovador RN and Eduardo Bruera MD
BACKGROUND
Five highly specific physical signs associated with death within 3 days among cancer patients were recently reported that may aid in the diagnosis of impending death. In this study, the frequency and onset of another 52 bedside physical signs and their diagnostic performance for impending death were examined.
METHODS
Three hundred fifty-seven consecutive patients with advanced cancer who had been admitted to acute palliative care units at 2 tertiary care cancer centers were enrolled. Fifty-two physical signs were systematically documented every 12 hours from admission to death or discharge. The frequency and median time of onset of each sign from death backwards were examined, and the likelihood ratios (LRs) associated with death within 3 days were calculated.
RESULTS
Two hundred three of the 357 patients (57%) died at the end of the admission. Eight physical signs that were highly diagnostic of impending death were identified. These signs occurred in 5% to 78% of the patients within the last 3 days of life, had a late onset, and had a high specificity (>95%) and a high positive LR for death within 3 days. They included nonreactive pupils (positive LR, 16.7; 95% confidence interval [CI], 14.9-18.6), a decreased response to verbal stimuli (positive LR, 8.3; 95% CI, 7.7-9), a decreased response to visual stimuli (positive LR, 6.7; 95% CI, 6.3-7.1), an inability to close eyelids (positive LR, 13.6; 95% CI, 11.7-15.5), drooping of the nasolabial fold (positive LR, 8.3; 95% CI, 7.7-8.9), hyperextension of the neck (positive LR, 7.3; 95% CI, 6.7-8), grunting of vocal cords (positive LR, 11.8; 95% CI, 10.3-13.4), and upper gastrointestinal bleeding (positive LR, 10.3; 95% CI, 9.5-11.1).
CONCLUSIONS
Eight highly specific physical signs associated with death within 3 days among cancer patients were identified. These signs may inform the diagnosis of impending death.