晚期恶性肿瘤患者临近死亡药物抢救临床价值分析

An analysis about clinical value of medicinal treatment for patients with advanced cancer near death

目的:比较恶性肿瘤晚期患者在临近死亡时接受药物抢救维持生命治疗与遵从自然病程之间生存时间的差异。方法:对符合入组条件的240例恶性肿瘤晚期死亡患者进行回顾性队列研究,其中抢救组患者169例,在临近死亡时予多巴胺、可拉明、洛贝林、肾上腺素等药物治疗;未抢救组患者71例,在临近死亡时仅监测生命体征变化,不予药物治疗。利用Kaplan-Meier法估计生存率,Log-rank检验法进行组间生存曲线比较,多因素Cox回归法分析影响生存时间的独立预后因素。结果:两组患者在性别、年龄、肿瘤类型、是否伴有肺部瘤灶、有无高血压或糖尿病等方面的分布无差异(P>0.05);抢救组与未抢救组之间生存曲线无显著差异(P=0.083);多因素Cox回归分析结果显示,抢救与否不是生存时间的独立预后因素(P=0.079)。结论:晚期恶性肿瘤患者在临近死亡时,接受抢救药物治疗与遵从自然病程相比并无明显生存获益。

Objectlve：To compare the difference of survival time between two groups accepting medicinal rescue versus following the natural course. Methods： Retrospectively analyze the data of 240 patients＂ medical records with advanced cancer, one group made up of 169 patients accepted medical treatment near death, such as dopamine, niketh- amide ,los behring, epinephrine, another group made up of 71 patients accepted nothing, using the method of Kaplan - Meier to estimate survival rate, the Log - rank test to compare survival curves between two groups, multivariable Cox regression to analyse independent prognostic factors influencing survival time. Results ：Gender,age,tumor type,accom- panied by pulmonary lesions,high blood pressure or diabetes between the two groups had no difference （ all P 〉 0.05 ）. Survival curve had no significant difference between two groups（ P = 0. 083 ）. Muhivariable Cox regression analysis re- sults showed that the treatment or not was not independent prognostic factor for survival time （ P = 0. 079 ）. Conclu- sion：Patients with advanced cancer have no significant survival benefit from medical treatment compared to following the natural course when near death.