緩和性鎮靜於末期疾病治療上應用之近況

Recent Advances in Palliative Sedation for Terminally Ill

Palliative Sedation (PS) is a widely used medical intervention by sedatives and analgesics to reduce patient's consciousness to relieve severely intolerable sufferings and refractory symptoms for the terminally ill. The intent of PS is to relieve the burden of patient and to do so in such a manner so to preserve the moral sensibilities of the patient, the medical professionals involved in their care, and concerned family and friends. This article will review the status of the recent applications, indications, concerns of staff and family, and the process of PS (patient's assessment, obtaining consent, sedative medications, patient's monitoring, the role of nutrition and hydration and the administration of previous medications). We also discuss the special applications of PS in palliative care settings, such as, in emergency situations, for respite and for psychological distress. The European Association for Palliative Care has developed a 10-item framework that addresses the key clinical issues to be considered when institutions are developing guidelines for PS. We summarize series studies and our experiences, which will be presented in this article separately.

緩和性鎮靜（Palliative Sedation簡稱PS）是應用鎮靜藥物，造成病人意識下降或失去意識，使生命末期難治之嚴重不適症狀及大量無法忍受之痛苦得以緩解。由於在運作當中，醫療人員、病人及家屬，有關執行的態度與倫理問題，須作深度的溝通及討論。本文列出各項相關的議題，包括：臨床上應用情況及適應症、醫療人員與家屬關心的問題、PS進行的步驟（病人的評估、同意書的取得、鎮靜藥物的使用及使用途徑方式、病人的監視、營養及水分給予之角色、最近服用藥物之持續使用…等）、緩和性鎮靜之特殊應用（緊急性鎮靜、喘息性鎮靜、難治的存在性或心理性不適之鎮靜…等），最後列出歐洲緩和醫學會提供的『緩和性鎮靜指引』10項架構（準則），給大家作擬訂PS指引之參考。本文除列舉過去各專家的研究心得外，並加入個人經驗，詳細加以論述。