Kouji KANEMOTO, Hiroaki SATOH, Hiroichi ISHIKAWA, Morio OHTSUKA, Katsunori KAGOHASHI, Koichi KURISHIMA

Psychotropic drugs for terminally ill patients with respiratory disease

Hipnotikler, sedatifler, parenteral morfin gibi psikotropik ilaçların son dönem akciğer hastalığı olanlarda kullanımıyla ilgili yeterli bildirim yapılmamıştır. Solunum hastalığı nedeniyle ölmekte olan hastalarda bu ilaçların kullanımını daha iyi anlamak için bu hastaların hayatlarının son dönemlerini inceledik. Nisan 2000-Mart 2005 tarihleri arasında solunum hastalığı nedeniyle ölen 337 hastanın son ayındaki semptomlar ve tedaviler tarandı. Hipnotikler malign hastaların %35.8’inde, malign olmayan hastaların ise %23.2’sinde; haloperidol ve midazolam gibi sedatifler malign hastaların %34.4’ünde, malign olmayan hastaların ise %30.4’ünde kullanılmış. Malign hastaların %65’i, malign olmayan hastaların %22.4’ü parenteral morfin kullanmış. Malign hastalarda morfin kullanımının üç ana nedeni ağrı, nefes darlığı ve son dönem huzursuzluğu idi. Malign olmayan hastaların hepsinde parenteral morfin kullanım nedeni dispne idi. Sonuçlarımız son dönem akciğer hastalığı olanların bir kısmında psikotropik ilaçlar ve parenteral morfin kullanımının gerektiğini göstermektedir. Her ne kadar dikkatli seçilmiş hastalarda uygulanması yeterli olsa da, bu hasta grubunda psikotropik ilaçların kullanımıyla ilgili rehberler gerekmektedir.

Son dönem akciğer hastalığı olan hastalar için psikotropik ilaçlar

Utilization of psychotropic drugs including hypnotics, sedatives, and parenteral morphine for terminally ill patients with respiratory disease has not been reported precisely. To better understand these drugs for dying patients with respiratory disease, we focused on the last month of life of them. A chart review, which was focused on symptoms and managements, in the last month of life of 337 patients who died of respiratory disease between April 2000 and March 2005 were performed. Hypnotics were prescribed in 35.8% and 23.2% of patients with malignant and non-malignant disease, respectively. Sedatives such as haloperidol and midazolam were utilized in 34.4% of patients with malignant disease, and 30.4% of those with non-malignant disease. Sixty-seven percent of patients with malignant and 22.4% of those with non-malignant disease had parenteral morphine. In patients with malignant disease, three of the main reasons for administration of morphine were pain, dyspnea, or terminal restlessness. In all of the patients with non-malignant disease, however, parenteral morphine was prescribed for the treatment of dyspnea. Our results showed that psychotropic drugs and parenteral morphine are required in some of terminally ill patients with respiratory disease. Although careful individualization of medication is appropriate, guideline for the prescribing psychotropic drugs for these patients will be required.

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