• 四川大學華西醫(yī)院老年科（四川成都 610041）;

目的 　針對近期收治的1例晚期肺癌呼吸困難患者，檢索當前最佳證據，為臨床合理治療提供依據。
方法 　計算機檢索 Cochrane 圖書館（2006 年第 2 期）SUMsearch （1978~2006）和 MEDLINE （1978~2006），查找有關治療癌性呼吸困難的系統評價和隨機對照試驗，并對所獲證據進行評價。
結果 　臨床證據表明，對癌性呼吸困難的對癥治療，有效的措施包括呼吸鍛煉和心理脫敏療法，口服或腸外給予阿片類和抗焦慮藥物等，伴有低氧血癥者可以從氧療中獲益。
結論 　癌性呼吸困難患者可以考慮物理、心理療法，氧療，阿片類及抗焦慮藥物治療。

引用本文： 舒德芬,董碧蓉. 一例惡性腫瘤晚期患者呼吸困難的循證治療. 中國循證醫(yī)學雜志, 2007, 07(10): 757-760. doi: 復制

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2. Guyatt GH, Rennie D, Editors, The Evidence-Based Medicine Working Group. Users Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
3. Solà I, Thompson E, Subirana M, et al. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. The Cochrane Database of Systematic Reviews 2004, Issue 4.
4. Jennings AL, Davies AN, Higgins JPT, et al. Opioids for the palliation of breathlessness in terminal illness. The　Cochrane Database of Systematic Reviews 2001, Issue 3.
5. Cohen MH, Anderson AJ, Krasnow SH, et al. Continuous intravenous infusion of morphine for severe dyspnea. South Med J, 1991; 84(2): 229-234.
6. Mazzocato C, Bucl in T, Rapin CH. The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol, 1999; 10(12): 1511-1514.
7. Hu WY, Chiu TY, Cheng SY, et al. Morphine for dyspnea control in terminal cancer patients: is it appropriate in Taiwan? J Pain Symptom Manage, 2004; 28(4): 356-363.
8. Grimbert D, Lubin O, de Monte M, et al. Dyspnea and morphine aerosols in the palliative care of lung cancer. Rev Mal Respir, 2004 ; 21(6 Pt 1): 1091-1097.
9. Zeppetella G. Nebul ized morphine in the palliation of dyspnoea. Palliat Med, 1997; 11(4): 267-275.
10. Bruera E, Sala R, Spruyt O, et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage, 2005; 29(6): 613-618.
11. Zebraski SE, Kochenash SM, Raffa RB. Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci, 2000; 66(23): 2221-2231.
12. Elsasser S, Perruchoud AP. The treatment of terminal dyspnea. Schweiz Rundsch Med Prax, 1992; 81(1-2): 11-14.
13. Thomas JR, von Gunten CF. Clinical management of dyspnoea. Lancet Oncol, 2002; 3(4): 223-228.
14. Navigante AH, Cerchietti LC, Castro MA, et al. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage, 2006; 31(1): 38-47.
15. Bruera E, de Stoutz N, Velasco-Leiva A, et al. Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet, 1993; 342(8862): 13-14.
16. Bruera E, Schoeller T, MacEachern T. Symptomatic benefit of supplemental oxygen in hypoxemic patients with terminal cancer: the use of the N of 1 randomized controlled trial. J Pain Symptom Manage, 1992; 7(6): 365-368.
17. Bruera E, Sweeney C, Willey J, et al. A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea. Palliat Med, 2003; 17(8): 659-663.
  1. 1. Mancini I, Body JJ. Assessment of dyspnea in advanced cancer patients. Support Care Cancer, 1999; 7(4): 229-232.
  2. 2. Guyatt GH, Rennie D, Editors, The Evidence-Based Medicine Working Group. Users Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
  3. 3. Solà I, Thompson E, Subirana M, et al. Non-invasive interventions for improving well-being and quality of life in patients with lung cancer. The Cochrane Database of Systematic Reviews 2004, Issue 4.
  4. 4. Jennings AL, Davies AN, Higgins JPT, et al. Opioids for the palliation of breathlessness in terminal illness. The　Cochrane Database of Systematic Reviews 2001, Issue 3.
  5. 5. Cohen MH, Anderson AJ, Krasnow SH, et al. Continuous intravenous infusion of morphine for severe dyspnea. South Med J, 1991; 84(2): 229-234.
  6. 6. Mazzocato C, Bucl in T, Rapin CH. The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol, 1999; 10(12): 1511-1514.
  7. 7. Hu WY, Chiu TY, Cheng SY, et al. Morphine for dyspnea control in terminal cancer patients: is it appropriate in Taiwan? J Pain Symptom Manage, 2004; 28(4): 356-363.
  8. 8. Grimbert D, Lubin O, de Monte M, et al. Dyspnea and morphine aerosols in the palliative care of lung cancer. Rev Mal Respir, 2004 ; 21(6 Pt 1): 1091-1097.
  9. 9. Zeppetella G. Nebul ized morphine in the palliation of dyspnoea. Palliat Med, 1997; 11(4): 267-275.
  10. 10. Bruera E, Sala R, Spruyt O, et al. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage, 2005; 29(6): 613-618.
  11. 11. Zebraski SE, Kochenash SM, Raffa RB. Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci, 2000; 66(23): 2221-2231.
  12. 12. Elsasser S, Perruchoud AP. The treatment of terminal dyspnea. Schweiz Rundsch Med Prax, 1992; 81(1-2): 11-14.
  13. 13. Thomas JR, von Gunten CF. Clinical management of dyspnoea. Lancet Oncol, 2002; 3(4): 223-228.
  14. 14. Navigante AH, Cerchietti LC, Castro MA, et al. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage, 2006; 31(1): 38-47.
  15. 15. Bruera E, de Stoutz N, Velasco-Leiva A, et al. Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet, 1993; 342(8862): 13-14.
  16. 16. Bruera E, Schoeller T, MacEachern T. Symptomatic benefit of supplemental oxygen in hypoxemic patients with terminal cancer: the use of the N of 1 randomized controlled trial. J Pain Symptom Manage, 1992; 7(6): 365-368.
  17. 17. Bruera E, Sweeney C, Willey J, et al. A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea. Palliat Med, 2003; 17(8): 659-663.