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首页> 外文期刊>The journals of gerontology.Series A. Biological sciences and medical sciences >Palliative care intervention for choice and use of opioids in the last hours of life.
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Palliative care intervention for choice and use of opioids in the last hours of life.

机译：在生命的最后几个小时中选择和使用阿片类药物的姑息治疗干预措施。

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BACKGROUND: The purpose of this study was to evaluate the effects of a multicomponent palliative care intervention on choice and use of opioid pain medications for symptom control for patients dying in an acute care inpatient setting. METHODS: A preintervention/postintervention trial was conducted between 2001 and 2003. Participants were physician, nursing, and ancillary staff of inpatient services of an urban, tertiary care Veterans Affairs (VA) Medical Center. The intervention included staff education to better identify actively dying patients and a Comfort Care Order Set to guide care in the last hours of life. Data abstracted from computerized medical records of 191 veterans who died during a 6-month period before (N=98) and after (N=93) the intervention were used to examine changes in choice and amount of medication administered in the last 3 days of life. RESULTS: Findings show a significant increase in orders specifically for morphine from 47.4% to 81.7% (p<.001). Orders for hydromorphone or oxycodone did not increase significantly, and no patients had orders for meperidine or codeine. There was an increase in the administration of opioids from 16.7% to 73.0% of patients (p<.001). The amount of opioid administered (in oral morphine equivalents) increased from 31.9 mg/72 hours preintervention to 52.9 mg/72 hours postintervention (p=.12). CONCLUSIONS: The results indicate that the availability of morphine as a preferred opioid and the number of patients who received opioid medication during the last 3 days of life increased after introduction of the inpatient palliative care program.
机译：背景：本研究的目的是评估多组分姑息治疗干预措施对选择和使用阿片类镇痛药物以控制死于急诊住院患者的症状的影响。方法：在2001年至2003年之间进行了干预前/干预后试验。参与者是城市，三级退伍军人事务（VA）医疗中心住院服务的医师，护理人员和辅助人员。干预措施包括员工培训，以更好地识别活跃死亡的患者，并提供一套舒适护理令，以指导生命中最后几个小时的护理。从干预前（N = 98）和之后（N = 93）的6个月内死亡的191例退伍军人的计算机病历中提取的数据用于检查治疗后3天内的选择和用药量变化生活。结果：研究结果显示，吗啡的订单量从47.4％显着增加到81.7％（p <.001）。氢吗啡酮或羟考酮的订购量没有明显增加，也没有患者接受哌替啶或可待因的订购。阿片类药物的使用率从16.7％增至73.0％（p <.001）。阿片类药物的服用量（口服吗啡当量）从干预前的31.9 mg / 72小时增加到干预后的52.9 mg / 72小时（p = .12）。结论：结果表明，引入住院姑息治疗计划后，吗啡作为首选阿片类药物的可获得性以及生命的最后3天接受阿片类药物治疗的患者人数有所增加。

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