卵巢上皮性癌患者临终期表现98例分析

Study of symptoms in terminally ill patients with ovarian carcinoma

目的探讨卵巢上皮性癌(卵巢癌)患者临终期表现的特点及规律。方法收集1995年1月至2004年12月在北京协和医院妇产科住院期间死亡的98例卵巢癌患者的临终期临床资料,对其常见的临终期症状、体征和并发症(以下简称为临终期表现,包括疼痛、恶液质、胸腹水、呼吸困难、发热、肠梗阻、肾功能衰竭、不可逆的骨髓抑制、肺部感染、出血、下肢深静脉血栓、消化道瘘、真菌感染、黄疸和各种急症)的发生率、发生后的存活时间以及各种临终期表现共存的规律、常见死亡原因进行分析。结果 (1)各种临终期表现的发生率:以胸腹水的发生率最高(63%),依次为疼痛(60%)、恶液质(59%)、呼吸困难(52%)、肠梗阻(49%)。(2)各种临终期表现出现后的存活时间:最长者为真菌感染(77 d),其次为消化道瘘(75 d)、肠梗阻(67 d)、疼痛(60 d)、恶液质(60 d)。比较凶险的临终期表现为不可逆的骨髓抑制、肾功能衰竭、呼吸困难和各种急症,存活时间中位数分别为14、13、12、7 d。(3)各种临终期表现共存的规律:临终期多以症候群为表现特点,每一患者同时存在(4.9±1.5)种临终期表现。同时存在4种及以上临终期表现者84例(86%),多表现为自然缓慢的病程,停止抗肿瘤治疗后的存活时间中位数为63 d;同时存在3种及以下临终期表现者14例(14%),存活时间中位数仅为25 d,两者生存时间比较,差异有统计学意义(P<0.01)。(4)卵巢癌患者的常见死亡原因中肠梗阻占首位(30%),其次为感染(15%)和各种急症(12%)。死于治疗并发症者5例(5%)。结论临终期表现有其特点和规律,加强认识有助于提高对临终期表现的管理水平,改善临终期患者的生活质量。

Objective To investigate symptom characteristics and their their prevalence in terminally ill patients with ovarian carcinoma. Methods A retrospective study was carried out based on clinical data of 98 terminally ill patients with ovarian carcinoma who died in our hospital during January 1995 to December 2004. Fifteen most common symptoms were analyzed with a focus on the followings： symptom incidence,survival time after symptom occurrence, regularity of symptom cluster, and common causes of death. Fifteen symptoms were： pain, cachexia, pleural effusion and ascites, dyspnea, fever, intestinal obstruction, renal failure, bone marrow depression, lung infection, hemorrhage, deep venous thrombosis （DVT）, intestinal or pancreatic fistula, mycotic infection, jaundice and emergency conditions. Results （1）The most prevalent symptom was pleural effusion and ascites （63%）, followed by pain （60%）, cachexia（59% ）, dyspnea（52% ） and intestinal obstruction （49%）. （2） The symptom which lasted longest survival time was mycotic infection （77 days）, followed by intestinal or pancreatic fistula （75 days）, intestinal obstruction（67 days）, pain（60 days） and cachexia（60 days）. Symptoms such as bone marrow depression, renal failure, dyspnea and emergency conditions were comparatively critical associated with shorter survival times （ 14, 13, 12,7 days, respectively）. （3） Terminal symptoms occurred typically in clusters, with 4. 9 ± 1.5 symptoms per case. Of 98 cases, 84 cases （86%） had 4 or more symptoms, with the median survival time of 63 days from the last day of anti-cancer therapy, and a slow death process. The remaining 14 cases （ 14% ） with 3 or fewer symptoms survived only 25 days, of which 10 cases （71%） died of emergency diseases. The survival time for two groups was significantly different（ P 〈 0.01 ）. （4）The first four causes of death were as follows： intestinal obstruction （30%） ,infection（ 15% ） ,emergencies（ 12% ） and treatment complications （5%）. Conclusion Symptom characteristics and regularity are seen in terminally ill patients with ovarian carcinoma, the understanding of which is helpful for the improvement of symptom management and patients＇ quality of life.