臨牀消化器内科 Vol.19 No.1(3-5)


特集名 消化器癌の緩和医療
題名 緩和医療におけるおもな症状に対するマネジメント (5) 呼吸困難
発刊年月 2004年 01月
著者 田中 桂子 静岡県立静岡がんセンター緩和医療科
【 要旨 】 呼吸困難は「呼吸時の不快な感覚」と定義される主観的症状であり,呼吸不全とは必ずしも一致しない.癌患者の呼吸困難の原因は,(1) 腫瘍によるもの,(2) 治療の影響,(3) その他に分類され,不安,抑うつなども重要な要因の一つとされる.評価のポイントは,(1) 量,(2) 質,(3) QOLへのインパクトである.呼吸困難のマネジメントについてAmerican Society of Clinical Oncologyの公式カリキュラムに従い,(1) 原因病態の治療,(2) 酸素療法,(3) モルヒネ,(4) 抗不安薬,(5) 非薬物療法,その他について概説した.癌患者の呼吸困難は“totaldyspnea”として捉え,多職種チームによりアプローチすることが重要である.
Theme Palliative Medicine for Patients with Gastrointestinal Cancer
Title Maintenance Treatment for Cancer Patients with Dyspnea
Author Keiko Tanaka Division of Palliative Medicine, Shizuoka Cancer Center Hospital
[ Summary ] Dyspnea is one of the most frequent and refractory symptoms in cancer patients. Dyspnea is a subjective symptom defined as "an uncomfortable sensation of breathing". It should be distinguished from respiratory failure, which is defined as hypoxia with PaO2<=60 torr. Causes of dyspnea in cancer patients are classified as (1) direct effect of the tumor, (2) effect of therapy, and (3) others. It is important to know that dyspnea is also related to psychological distress, such as anxiety. Assessment of dyspnea should be focused on (1) severity, (2) characteristics, and (3) impact on quality of life. The important points of management of dyspnea are described in this article according to the curriculum developed by the American Society of Clinical Oncology; (1) Treat the underlying causes (egantibiotics for pneumonia, blood transfusion for anemia), (2) administer oxygen, (3) morphine, (4) anxiolytics, and (5) non-pharmacological interventions, such as respiratory rehabilitation and relaxation. Since dyspnea in cancer patients has multidimensional aspects, an interdisciplinary team approach for symptom management is important.
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