癌症晚期/生命有限患者的姑息性镇静治疗（二）

Palliative sedation therapy for patients in advanced caner and in life limitation （2）

姑息性镇静治疗决定前要提出初始申请,填写知情同意书;此外,作决定还必须评估和分析是否符合指证;对患者的信息分析并做出决定包括客观的适应证,镇静治疗的性质,药物选择和剂量.病历中应该含有作决定的和相关的资料,与患者和/或家属,照护者讨论,咨询和会诊的记录.决定存在争议时要用专业化知识作判定;医生缺乏经验应该首选姑息医学的专家会诊;紧急情况下医生有权利作出决定.与患者/监护人的交流是十分重要的;开始实施镇静治疗是个情感冲突的时刻,要求医生在现场;其后的管理可由护士和其他的照护者完成.是否输液治疗有一定的争议.

The initial proposal for palliative sedation therapy should be raised, and the consent of the patient should be completed before initiating palliative sedatiom besides, the patient＇s situation must be evaluated and assessed thoroughly in the light of the medical indications and conditions be- fore deciding to administer palliative sedation; This assessment and decision-making of palliative se- dation should include information which are the objection indications, the nature of the sedation, the choice of drugs, and the dose to be administered. The decision itself and the considerations on which it is based must be documented in the patient＇s medical file. The file should also contain notes on the consultations held with the patient and/or with his family, and with any consultants. There must al- ways be sufficient expertise to make a valid decision when palliative sedation is at issue. If the physi- cian possesses insufficient expertise, an appropriate expert, preferably a palliative care specialist should be consulted. In acute situations, the physician has the discretionary power to make the deci- sion on the basis of the patient＇s condition. Communication with the patients, relatives and /or his representatives is crucial. Initiating palliative sedation is an emotionally charged moment, the atten- ding physician should be present when palliative sedation is initiated. Afterwards, the administration of sedation can be left largely to nurses and other caregivers. There is controversy whether the fluids artificially administered during palliative sedation therapy.