42例生命终末期血液肿瘤患儿在临终关怀治疗中症状分析

Symptom analysis of 42 children with cancer at the end of life in hospice care

目的通过分析雏菊之家收治的42例生命终末期血液肿瘤患儿的症状资料,为改善儿童临终关怀治疗措施、为患儿及其家庭获得更好的帮助提供依据。方法通过量表收集并分析2019年1月—2020年12月期间,中国老龄事业发展基金会北京松堂关怀医院雏菊之家收治的42例生命终末期血液肿瘤患儿症状等相关病例资料。结果42例患儿中24例为男性,18例为女性。实体瘤占76%(32/42例)。入住到死亡中位时间为14d,中位死亡年龄为63个月。所有患儿均出现不同的不适症状,患儿及家属报告的主要症状有疲劳(91%)、睡眠不安(88%)、疼痛(88%)、恶心(62%)、口干(60%)、呕吐(57%)、厌食(55%)、发热(48%)、便秘(45%)、意识障碍(36%)、尿潴留(33%)、呼吸困难(33%)等。每个人平均报告的症状数9.55(1~16)个。轻度疼痛占24%(10/42例),中至重度疼痛占64%(27/42例),需要积极镇痛治疗。患儿的ECOG体力评分76%为4分,表示生活不能自理,需24h看护。实体瘤和非实体肿瘤症状发生率比较,实体瘤患儿发生疼痛的概率更高,尤其是重度疼痛,结果存在统计学差异。结论血液肿瘤儿童在临终过程中可出现多种症状,半数以上可出现疲劳、睡眠不安、疼痛、恶心、口干、呕吐、厌食症状,绝大多数患儿需24h看护。临终关怀治疗中需积极控制症状,尤其是疼痛。在不延长患儿生命且不造成患儿更大痛苦的情况下,灵活应用药物及非药物治疗。

Objective To provide evidence for improving palliative care for children and providing better help for children and their families by analyzing the symptom data of 42 children with cancer at the end of life treated in Daisy House.Methods From January 2019 to December 2020,42 children with cancer at end-of-life symptoms in Daisies Home were collected and analyzed using the scale.Results Of the 42 cases,24 were male and 18 were female.Solid tumors accounted for 76%(32/42cases).The median time of arrival to death was 14 days,and the median age of death was 63 months.The main symptoms reported by the children and their families were fatigue(91%),restlessness in sleep(88%),pain(88%),nausea(62%),dry mouth(60%),vomiting(57%),anorexia(55%),fever(48%),constipation(45%),disturbance of consciousness(36%),urinary retention(33%),dyspnea(33%),et al.The average number of symptoms reported per person was 9.55(1~16).Mild pain accounted for 24%(10/42 cases),moderate to severe pain accounted for 64%(27/42 cases),both requiring analgesic treatment.The ECOG score of 76%was 4,indicating that the children could not take care of themselves.Compared with the incidence of symptoms of solid tumors and non solid tumors,children with solid tumors have a higher probability of pain,especially severe pain.The results are statistically different.Conclusions Children with hematological tumors may have a variety of symptoms during end of life.More than half of them may have fatigue,sleep disturbance,pain,nausea,dry mouth,vomiting,anorexia.The majority of children need 24-hour nursing.Active control of symptoms,especially pain,is needed in hospice care.In the case of not prolonging the child′s life and not causing more pain to the child,application of drug and non-drug therapy should be flexible choice.