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摘要: 呼吸困难是一种自觉症状, 其给晚期癌症患者带来了巨大痛苦。有效评估和处理晚期癌症患者的呼吸困难是一线临床医生和专业护理人员应具备的核心能力, 中国目前尚缺乏此方面的规范处理流程。基于循证医学证据, 美国临床肿瘤学会发布了"晚期癌症呼吸困难处理实践指南", 该指南针对晚期癌症患者给出了呼吸困难评估和分级处理策略。本文结合中国国情, 旨在对该指南中的关键内容进行详细解读, 以期为中国的临床实践提供指导和借鉴。Abstract: Dyspnea, the subjective sensation of breathlessness, is a common source of distress for patients living with advanced cancer. Effective assessment and management of dyspnea among patients living with advanced cancer represents core competencies for front-line clinicians and professional caregivers. However, there is still a lack of standardized procedures for handling dyspnea in China. Based on evidence-based medicine, the American Society of Clinical Oncology practice guidelines for management of dyspnea in advanced cancer was released, which outlines assessment and management of dyspnea among patients living with advanced cancer. This article aims to provide detailed interpretation of key clinical content to guide China's clinical practice.
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Key words:
- late stage cancer /
- difficulty breathing /
- palliative care /
- guideline interpretation
作者贡献：贾之萌提出选题思路，撰写论文；Colman Rebecca、宁晓红负责撰写、修订论文。利益冲突：所有作者均声明不存在利益冲突 -
图 1 晚期癌症患者急慢性呼吸困难分级干预策略
Figure 1. Pathway for managing acute and chronic dyspnea in advanced cancer
表 1 根据临床环境和呼吸困难严重程度建议的阿片类药物治疗方案*
Table 1. Suggested opioid regimen tailored to clinical setting and acuity of dyspnea*
临床情境 呼吸困难严重程度 未使用过阿片类药物 阿片类药物耐受 住院 急性、严重 根据需要每小时静脉或皮下注射2 mg吗啡 根据需要，每小时服用10%~25%吗啡当量的阿片类药物 门诊 事件或活动诱发 根据需要每小时口服或舌下含服5~10 mg吗啡，活动前30 min给药 根据需要，每小时服用15%~45%吗啡当量的阿片类药物，活动前30 min服用 门诊 慢性 每天口服10~30 mg吗啡，短效或长效剂量分次服用 阿片类药物基础剂量增加30% *建议的阿片类药物治疗方案以吗啡为例，临床医生可考虑使用同等剂量的氢吗啡酮、羟考酮、美沙酮或氢可酮 
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