Chinese Guideline for Use of Essential Medicines in Palliative and Hospice Care

doi:10.12114/j.issn.1007-9572.2021.00.418

Abstract

Abstract: Palliative and hospice care are medical specialities that provide multidisciplinary supports to help improve painful physical and/or mental symptoms to improve the quality of life till passing away with dignity and comfort in patients of all ages in the end or terminal stage of various incurable conditions.Rational use of medicines is one of the essential components in palliative and hospice care.Therefore，the guideline panel initiated the first Chinese Guideline for Use of Essential Medicines in Palliative and Hospice Care based on relevant research and clinical practice following the international criteria for guideline development.Focusing on 33 physical，mental and refractory symptoms of diseases affecting the whole body and various systems commonly seen in patients with terminal conditions，this guideline recommends 23 medicines for symptom control，20 of which are included in the current National Essential Medicines List.To facilitate the accessibility of medical workers for reference，the guideline describes in detail the fundamental theories of palliative and hospice care，principles of clinical prescription，as well as matters about rational usage，dosage and precautions of related drugs.This guideline helps to improve the quality of care for end-stage patients in various clinical specialities，basically ensuring that they can obtain care with comfort and dignity，and filling a gap in domestic development of palliative and hospice care.

Key words: Palliative care, Hospice care, Essential medicines, Guideline

摘要： 姑息治疗与安宁疗护是通过多学科协作的模式，有效改善患者的痛苦症状、提高生活质量，直至其舒适、有尊严离世的新兴临床学科，适用于各年龄阶段，罹患现代医学无法治愈，并伴有躯体和/或精神心理症状，严重影响生活质量的疾病终末期和临终期患者。合理使用药物是姑息治疗与安宁疗护中最为重要的内容之一，因此，指南工作组依照国际指南的制定标准、结合国内外相关研究和临床实践，制订了我国首部《姑息治疗与安宁疗护基本用药指南》。该指南围绕各种疾病终末期和临终期患者常见的33个全身性和各系统的躯体、精神心理症状及难治性症状，推荐23种治疗药物，其中20种药物收录于我国现行《国家基本药物目录》。为便于广大医务人员参阅学习，指南详细阐述了姑息治疗与安宁疗护专科的基本理论、临床用药原则、相关药物的用法用量和注意事项等内容。该指南的制定有助于提升各临床学科对疾病终末期和临终患者的诊疗服务质量，是确保患者获得舒适与尊严性医疗服务的基本保障，同时填补了我国姑息治疗与安宁疗护学科发展的空白。

关键词: 姑息治疗, 安宁疗护, 基本药物, 指南

General Practice Branch of Cross-Strait Medicine Exchange Association. Chinese Guideline for Use of Essential Medicines in Palliative and Hospice Care　[J]. Chinese General Practice, 2021, 24(14): 1717-1734. DOI: 10.12114/j.issn.1007-9572.2021.00.418.
海峡两岸医药卫生交流协会全科医学分会. 姑息治疗与安宁疗护基本用药指南[J]. 中国全科医学, 2021, 24(14): 1717-1734. DOI: 10.12114/j.issn.1007-9572.2021.00.418.

References

［1］TWYCROSS R，WILCOCK A.Introducing Palliative Care［M］．5th ed.Britain：Pharmaceutical Press，2018.

［2］DANS M，KUTNER J S，BAKER J N，et al．NCCN clinical practice guidelines in oncology：palliative care（2019.V1）［EB/OL］．（2018-12-10）［2020-09-16］．https：//www.nccn.org/default.aspx.

［3］MCILVENNAN C K，ALLEN L A.Palliative care in patients with heart failure［J］．BMJ，2016，353：i1010．DOI：10.1136/bmj.i1010.

［4］Standards Development Subgroup of the National Strategy for Palliative Care Implementation Taskforce.National Guidelines for Palliative Care and Interpretation Guide［EB/OL］．（2015-01-20）［2020-09-20］．https：//singaporehospice.org.sg/site2019/wp-content/uploads/National-Guidelines-for-Palliative-Care-Revised-Ed.-Jan-2015.pdf.

［5］国家卫生计生委办公厅.国家卫生计生委办公厅关于印发安宁疗护实践指南（试行）的通知［EB/OL］．（2017-02-09）［2020-07-12］．http：//www.nhc.gov.cn/yzygj/s3593/201702/83797c0261a94781b158dbd76666b717.shtml．

［6］RHYMES J.Hospice care in America［J］．JAMA，1990，264（3）：369-372.

［7］KELLEY A S，MORRISON R S.Palliative care for the seriously ill［J］．N Engl J Med，2015，373（8）：747-755．DOI：10.1056/NEJMra1404684.

［8］BUSS M K，ROCK L K，MCCARTHY E P.Understanding palliative care and hospice：a review for primary care providers［J］．Mayo Clin Proc，2017，92（2）：280-286．DOI：10.1016/j.mayocp.2016.11.007.

［9］SWARM R A，PAICE J A，ANGHELESCU D L，et al．Adult cancer pain，version 1.2019，NCCN clinical practice guidelines in oncology［J］．J Natl Compr Canc Netw，2019，17（8）：977-1007．DOI：10.6004/jnccn.2019.0038.

［10］Worldwide Palliative Care Alliance.Global Atlas of Palliative Care at the End of Life［EB/OL］．（2014-01）［2020-09-16］．http：//www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf.

［11］CHEN M L.Inequity of palliative care for non-cancer patients［J］．J Nurs Res，2019，27（2）：1-2．DOI：10.1097/jnr.0000000000000324.

［12］李小鹰.老年医学［M］．北京：人民卫生出版社，2015.

［13］RAJA S N，CARR D B，COHEN M，et al．The revised International Association for the Study of Pain definition of pain：concepts，challenges，and compromises［J］．Pain，2020DOI：10.1097/j.pain.0000000000001939．DOI：10.1097/j.pain.0000000000001939.

［14］SNOW A L，CHANDLER J F，KUNIK M E，et al．Self-reported pain in persons with dementia predicts subsequent decreased psychosocial functioning［J］．Am J Geriatr Psychiatry，2009，17（10）：873-880．DOI：10.1097/JGP.0b013e3181ad4f73.

［15］PAUTEX S，HERRMANN F R，MICHON A，et al．Psychometric properties of the doloplus-2 observational pain assessment scale and comparison to self-assessment in hospitalized elderly［J］．Clin J Pain，2007，23（9）：774-779．DOI：10.1097/ajp.0b013e318154b6e3.

［16］TENO J M，CLARRIDGE B R，CASEY V，et al．Family perspectives on end-of-life care at the last place of care［J］．JAMA，2004，291（1）：88-93．DOI：10.1001/jama.291.1.88.

［17］KNAUS W A，JR CONNORS A F，DAWSON N V，et al．Joanne Lynn A controlled trial to improve care for seriously ill hospitalized patients.The study to understand prognoses and preferences for outcomes and risks of treatments（SUPPORT）［J］．JAMA，1995，274（20）：1591-1598.

［18］VAN DEN BEUKEN-VAN EVERDINGEN M H，DE RIJKE J M，KESSELS A G，et al．Prevalence of pain in patients with cancer：a systematic review of the past 40 years［J］．Ann Oncol，2007，18（9）：1437-1449．DOI：10.1093/annonc/mdm056.

［19］中华人民共和国国家卫生健康委员会国卫办医函.癌症疼痛诊疗规范（2018年版）［J］．临床肿瘤学杂志，2018，23（10）：937-944.

National Health Commission of the People's Republic of China.Standard diagnosis and treatment of cancer pain（version 2018）［J］．Chinese Clinical Oncology，2018，23（10）：937-944.

［20］JARA C，DEL BARCO S，GRÁVALOS C，et al．SEOM clinical guideline for treatment of cancer pain（2017）［J］．Clin Transl Oncol，2018，20（1）：97-107．DOI：10.1007/s12094-017-1791-2.

［21］YAMAGUCHI T，SHIMA Y，MORITA T，et al．Clinical guideline for pharmacological management of cancer pain：the Japanese Society of Palliative Medicine recommendations［J］．Jpn J Clin Oncol，2013，43（9）：896-909．DOI：10.1093/jjco/hyt099.

［22］BLINDERMAN C D，BILLINGS J A.Comfort care for patients dying in the hospital［J］．N Engl J Med，2015，373（26）：2549-2561．DOI：10.1056/NEJMra1411746.

［23］国家药典委员会.中华人民共和国药典临床用药须知（化学药和生物制品卷）：2015年版［M］．北京：中国医药科技出版社，2017.

［24］FRIEDRICHSDORF S J.From tramadol to methadone：opioids in the treatment of pain and dyspnea in pediatric palliative care［J］．Clin J Pain，2019，35（6）：501-508．DOI：10.1097/AJP.0000000000000704.

［25］北京市疼痛治疗质量控制和改进中心癌痛专家组.北京市癌症疼痛管理规范（2017年版）［J］．中国疼痛医学杂志，2017，23（12）：881-889．DOI：10.3969/j.issn.1006-9852.2017.12.001.

［26］FALLON M，GIUSTI R，AIELLI F，et al．Management of cancer pain in adult patients：ESMO Clinical Practice Guidelines［J］．Ann Oncol，2018，29（Suppl 4）：iv166-191．DOI：10.1093/annonc/mdy152.

［27］KING S，FORBES K，HANKS G W，et al．A systematic review of the use of opioid medication for those with moderate to severe cancer pain and renal impairment：a European Palliative Care Research Collaborative opioid guidelines project［J］．Palliat Med，2011，25（5）：525-552．DOI：10.1177/0269216311406313.

［28］GOURLAY G K.Treatment of cancer pain with transdermal fentanyl［J］．Lancet Oncol，2001，2（3）：165-172．DOI：10.1016/s1470-2045（00）00258-8.
［29］胡夕春，王杰军，常建华，等．癌症疼痛诊疗上海专家共识（2017年版）［J］．中国癌症杂志，2017，27（4）：312-320．DOI：10.19401/j.cnki.1007-3639.2017.04.012.
［30］BENNETT M I.Effectiveness of antiepileptic or antidepressant drugs when added to opioids for cancer pain：systematic review［J］．Palliat Med，2011，25（5）：553-559．DOI：10.1177/0269216310378546.
［31］DUREJA G P，IYER R N，DAS G，et al．Evidence and consensus recommendations for the pharmacological management of pain in India［J］．J Pain Res，2017，10：709-736．DOI：10.2147/JPR.S128655.
［32］PORTENOY R K，HAGEN N.Breakthrough pain：definition，prevalence and characteristics［J］．Pain，1990，41（3）：273-281．DOI：10.1016/0304-3959（90）90004-W.
［33］BENNETT M I，GRAHAM J，SCHMIDT-HANSEN M，et al．Prescribing strong opioids for pain in adult palliative care：summary of NICE guidance［J］．BMJ，2012，344：e2806．DOI：10.1136/bmj.e2806.
［34］CARACENI A，DAVIES A，POULAIN P，et al．Guidelines for the management of breakthrough pain in patients with cancer［J］．J Natl Compr Canc Netw，2013，11（Suppl 1）：S29-36．DOI：10.6004/jnccn.2013.0211.
［35］DAVIES A N，DICKMAN A，REID C，et al．The management of cancer-related breakthrough pain：recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland［J］．Eur J Pain，2009，13（4）：331-338．DOI：10.1016/j.ejpain.2008.06.014.
［36］中国抗癌协会癌症康复与姑息治疗专业委员会难治性癌痛学组，中华医学会疼痛学分会癌痛学组.癌性爆发痛专家共识（2019年版）［J］．中国肿瘤临床，2019，46（6）：267-271．DOI：10.3969/j.issn.1000-8179.2019.06.228.
［37］中国抗癌协会癌症康复与姑息治疗专业委员会（RPC）难治性癌痛学组.难治性癌痛专家共识（2017年版）［J］．中国肿瘤临床，2017，44（16）：787-793．DOI：10.3969/j.issn.1000-8179.20107.16.714.
［38］BODY J J，DIEL I J，LICHINITZER M，et al．Oral ibandronate reduces the risk of skeletal complications in breast cancer patients with metastatic bone disease：results from two randomised，placebo-controlled phase III studies［J］．Br J Cancer，2004，90（6）：1133-1137．DOI：10.1038/sj.bjc.6601663.
［39］ROSEN L S，GORDON D，KAMINSKI M，et al．Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma：a phase III，double-blind，comparative trial［J］．Cancer J，2001，7（5）：377-387.
［40］WARDLEY A，DAVIDSON N，BARRETT-LEE P，et al．Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases：a randomised，crossover study of community vs hospital bisphosphonate administration［J］．Br J Cancer，2005，92（10）：1869-1876．DOI：10.1038/sj.bjc.6602551.
［41］American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons.Pharmacological management of persistent pain in older persons［J］．J Am Geriatr Soc，2009，57（8）：1331-1346．DOI：10.1111/j.1532-5415.2009.02376.x.
［42］GRALOW J，TRIPATHY D.Managing metastatic bone pain：the role of bisphosphonates［J］．J Pain Symptom Manage，2007，33（4）：462-472．DOI：10.1016/j.jpainsymman.2007.01.001.
［43］AIDOO E，RAJAPAKSE D.End of life care for infants，children and young people with life-limiting conditions：planning and management：the NICE guideline 2016［J］．Arch Dis Child Educ Pract Ed，2018，103（6）：296-299．DOI：10.1136/archdischild-2017-312767.
［44］RAFF M，CROSIER J，EPPEL S，et al．South African guideline for the use of chronic opioid therapy for chronic non-cancer pain［J］．S Afr Med J，2014，104（1 suppl 1）：78-89．DOI：10.7196/samj.7316.
［45］SWARM R A，PAICE J A，ANGHELESCU D L，et al．NCCN clinical practice guidelines in oncology：adult cancer pain（2018.V1）［EB/OL］．（2018-01-22）［2020-09-16］．https：//www.nccn.org/default.aspx.
［46］陈新谦，金有豫，汤光.陈新谦新编药物学［M］．18版.北京：人民卫生出版社，2019.
［47］国家基本药物临床应用指南和处方集编委会.国家基本药物处方集（化学药品和生物制品）：2018年版［M］．北京：人民卫生出版社，2019.
［48］URBAN D，CHERNY N，CATANE R.The management of cancer pain in the elderly［J］．Crit Rev Oncol Hematol，2010，73（2）：176-183．DOI：10.1016/j.critrevonc.2009.03.008.
［49］万学红，陈红.临床诊断学［M］．3版.北京：人民卫生出版社，2015.
［50］STRICKLAND M，STOVSKY E.Fever near the end of life #256［J］．J Palliat Med，2012，15（8）：947-948．DOI：10.1089/jpm.2012.9572.
［51］HUNG Y S，CHEN C H，YEH K Y，et al．Potential benefits of palliative care for polysymptomatic patients with late-stage nonmalignant disease in Taiwan［J］．J Formos Med Assoc，2013，112（7）：406-415．DOI：10.1016/j.jfma.2011.08.021.
［52］刘畅，徐萌.清热解毒类中药治疗癌性发热的Meta分析［J］．山东医药，2013，53（40）：1-5．DOI：10.3969/j.issn.1002-266X.2013.40.001.
LIU C，XU M.Qingrejiedu-category Chinese medicine in treatment of cancerous fever：a meta-analysis［J］．Shandong Medical Journal，2013，53（40）：1-5．DOI：10.3969/j.issn.1002-266X.2013.40.001.
［53］TOUSSAINT E，BAHEL-BALL E，VEKEMANS M，et al．Causes of fever in cancer patients（prospective study over 477 episodes）［J］．Supportive Care Cancer，2006，14（7）：763-769．DOI：10.1007/s00520-005-0898-0.

［54］WARRELL M，WARRELL D A，TARANTOLA A.The imperative of palliation in the management of rabies encephalomyelitis［J］．Trop Med Infect Dis，2017，2（4）：52．DOI：10.3390/tropicalmed2040052．DOI：10.3390/tropicalmed2040052.

［55］WATSON M S，LUCAS C F，HOY A M，et al．Oxford handbook of palliative care［M］．First Edition.Oxford University Press，Incorporated，2006.
［56］陆宇晗，陈钒.肿瘤姑息护理实践指导［M］．北京：北京大学医学出版社，2017.
［57］万学红，卢雪峰.诊断学［M］．8版.北京：人民卫生出版社，2013.
［58］FERRELL B R，COYLE N，PAICE J.2010 Oxford Textbook Of Palliative Nursing［M］．4th Edition.Oxford University Press，Incorporated，2015.
［59］REAL S，COBBE S，SLATTERY S.Palliative care edema：patient population，causal factors，and types of edema referred to a specialist palliative care edema service［J］．J Palliat Med，2016，19（7）：771-777．DOI：10.1089/jpm.2015.0337.
［60］LEE C H，KIM J K，JUN H J，et al．Rehabilitation of advanced cancer patients in palliative care unit［J］．Ann Rehabil Med，2018，42（1）：166-174．DOI：10.5535/arm.2018.42.1.166.
［61］WOO J，LO R，CHENG J O，et al．Quality of end-of-life care for non-cancer patients in a non-acute hospital［J］．J Clin Nurs，2011.20（13/14）：1834-1841．DOI：10.1111/j.1365-2702.2010.03673.x.
［62］贾贻红，邵波.螺内酯和呋塞米联合应用对肝炎后肝硬化腹水的疗效评价［J］．中国医药指南，2015，13（22）：122-123.
［63］MECHLER K，LIANTONIO J.Palliative care approach to chronic diseases：end stages of heart failure，chronic obstructive pulmonary disease，liver failure，and renal failure［J］．Prim Care，2019，46（3）：415-432．DOI：10.1016/j.pop.2019.05.008.
［64］中国医师协会皮肤科分会变态反应性疾病专业委员会.慢性瘙痒管理指南（2018版）［J］．中华皮肤科杂志，2018，51（7）：481-485．DOI：10.3760/cma.j.issn.0412-4030.2018.07.001.
［65］PORTENOY R K，THALER H T，KORNBLITH A B，et al．Symptom prevalence，characteristics and distress in a cancer population［J］．Qual Life Res，1994，3（3）：183-189．DOI：10.1007/BF00435383.
［66］MANENTI L，TANSINDA P，VAGLIO A.Uraemic pruritus：clinical characteristics，pathophysiology and treatment［J］．Drugs，2009，69（3）：251-263．DOI：10.2165/00003495-200969030-00002.
［67］KUMAR N，GARG N，BAILEY A.Opiate receptor antagonists for treatment of severe pruritus associated with advanced cholestatic liver disease［J］．J Palliat Med，2013，16（2）：122-123．DOI：10.1089/jpm.2012.0452.
［68］WEISSHAAR E，SZEPIETOWSKI J C，DALGARD F J，et al．European S2k Guideline on Chronic Pruritus［J］．Acta Dermato Venereologica，2019，99（5）：469-506．DOI：10.2340/00015555-3164.
［69］张学军，郑捷.皮肤性病学［M］．9版.北京：人民卫生出版社，2018.
［70］王宏伟，张洁尘.老年皮肤瘙痒症诊断与治疗专家共识［J］．中国皮肤性病学杂志，2018，32（11）：1233-1237．DOI：10.13735/j.cjdv.1001-7089.201808168.
［71］ANAND S.Gabapentin for pruritus in palliative care［J］．Am J Hosp Palliat Care，2013，30（2）：192-196．DOI：10.1177/1049909112445464.
［72］International Association for Hospice and Palliative Care（IAHPC）.Essential medicines in palliative care［EB/OL］．（2013-01）［2020-09-16］．https：//www.who.int/selection_medicines/committees/expert/19/applications/PalliativeCare_8_A_R.pdf.
［73］TEUNISSEN S C，WESKER W，KRUITWAGEN C，et al．Symptom prevalence in patients with incurable cancer：a systematic review［J］．J Pain Symptom Manage，2007，34（1）：94-104．DOI：10.1016/j.jpainsymman.2006.10.015.
［74］MÜCKE M，MOCHAMAT M，CUHLS H，et al．Pharmacological treatments for fatigue associated with palliative care［J］．Cochrane Database Syst Rev，2015，2015（5）：CD006788．DOI：10.1002/14651858.CD006788.pub3.
［75］BERGER A M，MOONEY K，BANERJEE C，et al．NCCN clinical practice guidelines in oncology：cancer-related fatigue（2020.V1）［EB/OL］．（2020-02-21）［2020-09-16］．https：//www.nccn.org/default.aspx.
［76］PAULSEN O，KLEPSTAD P，ROSLAND J H，et al．Efficacy of methylprednisolone on pain，fatigue，and appetite loss in patients with advanced cancer using opioids：a randomized，placebo-controlled，double-blind trial［J］．J Clin Oncol，2014，32（29）：3221-3228．DOI：10.1200/JCO.2013.54.3926.
［77］MATSUO N，MORITA T，IWASE S.Physician-reported corticosteroid therapy practices in certified palliative care units in Japan：a nationwide survey［J］．J Palliat Med，2012，15（9）：1011-1016．DOI：10.1089/jpm.2011.0534.
［78］MATSUO N，MORITA T，IWASE S.Efficacy and undesirable effects of corticosteroid therapy experienced by palliative care specialists in Japan：a nationwide survey［J］．J Palliat Med，2011，14（7）：840-845．DOI：10.1089/jpm.2011.0002.
［79］BEGLEY S，ROSE K，O'CONNOR M.The use of corticosteroids in reducing cancer-related fatigue：assessing the evidence for clinical practice［J］．Int J Palliat Nurs，2016，22（1）：5-9．DOI：10.12968/ijpn.2016.22.1.5.
［80］MATSUO N，MORITA T，MATSUDA Y，et al．Predictors of responses to corticosteroids for cancer-related fatigue in advanced cancer patients：a multicenter，prospective，observational study［J］．J Pain Symptom Manag，2016，52（1）：64-72．DOI：10.1016/j.jpainsymman.2016.01.015.
［81］YENNURAJALINGAM S，FRISBEE-HUME S，PALMER J L，et al．Reduction of cancer-related fatigue with dexamethasone：a double-blind，randomized，placebo-controlled trial in patients with advanced cancer［J］．J Clin Oncol，2013，31（25）：3076-3082．DOI：10.1200/JCO.2012.44.4661.
［82］PRESTON N J，HURLOW A，BRINE J，et al．Blood transfusions for anaemia in patients with advanced cancer［J］．Cochrane Database Syst Rev，2012，2012（2）：CD009007．DOI：10.1002/14651858.CD009007.pub2.
［83］RADBRUCH L，ELSNER F，TROTEENBERG P，et al．Clinical practice guidelines on cancer cachexia in advanced cancer patients with a focus on refractory cachexia［J］．Aachen，Department of Palliative Medicinen/ European Palliative Care Research Collaborative，2010.http：//www.epcrc.org.

［84］ZHONG X L，ZIMMERS T A.Sex differences in cancer cachexia［J］．Curr Osteoporos Rep，2020，18（6）：646-654．DOI：10.1007/s11914-020-00628-w.

［85］VON HAEHLING S，ANKER M S，ANKER S D.Prevalence and clinical impact of cachexia in chronic illness in Europe，USA，and Japan：facts and numbers update 2016［J］．J Cachexia Sarcopenia Muscle，2016，7（5）：507-509．DOI：10.1002/jcsm.12167.

［86］MILLER S，MCNUTT L，MCCANN M A，et al．Use of corticosteroids for anorexia in palliative medicine：a systematic review［J］．J Palliat Med，2014，17（4）：482-485．DOI：10.1089/jpm.2013.0324.

［87］MELSTROM L G，MELSTROM K A Jr，DING X Z，et al．Mechanisms of skeletal muscle degradation and its therapy in cancer cachexia［J］．Histol Histopathol，2007，22（7）：805-814．DOI：10.14670/HH-22.805.

［88］MIRRAKHIMOV A E.Hypercalcemia of malignancy：an update on pathogenesis and management［J］．N Am J Med Sci，2015，7（11）：483-493．DOI：10.4103/1947-2714.170600.

［89］谷伟军.内分泌相关高钙血症的临床对策［J］．药品评价，2014，11（1）：12-16.

GU W J.Clinical Strategies of endocrine-related hypercalcemia［J］．Drug Evaluation，2014，11（1）：12-16.

［90］孙婷婷，刘金波，马利丹，等．高钙血症病人55例临床分析［J］．青岛大学医学院学报，2018，54（4）：476-479．DOI：10.11712/jms201804025.

SUN T T，LIU J B，MA L D，et al．Etiology and clinical manifestations of hypercalcemia：an analysis of 55 cases［J］．Acta Aacademiae Medicinae Qingdao Universitatis，2018，54（4）：476-479．DOI：10.11712/jms201804025.

［91］ZEPPETELLA G.Palliative care in clinical practice［M］．Fifth Edition．Springer，2012．

［92］RALSTON S H，GALLACHER S J，PATEL U，et al．Cancer-associated hypercalcemia：morbidity and mortality.Clinical experience in 126 treated patients［J］．Ann Intern Med，1990，112（7）：499-504．DOI：10.7326/0003-4819-112-7-499.

［93］MACLEOD R D，LIEVE V D B.Textbook of Palliative Care || Hypercalcemia of Malignancy［EB/OL］．（2018-04-12）［2020-09-15］．https：//doi.org/10.1007/978-3-319-31738-0_70-1.

［94］TINTI S，DE MARIA B，PARATI M，et al．Italian version of cancer dyspnea scale：cultural-linguistic and clinical validation in patients with advanced cancer disease in palliative care settings［J］．J Pain Symptom Manage，2021，61（3）：571-578.e1．DOI：10.1016/j.jpainsymman.2020.10.008.

［95］KLOKE M，CHERNY N，ESMO GUIDELINES COMMITTEE.Treatment of dyspnoea in advanced cancer patients：ESMO Clinical Practice Guidelines［J］．Ann Oncol，2015，26（Suppl 5）：v169-173．DOI：10.1093/annonc/mdv306.

［96］DANS M，KUTNER J S，BAKER J N，et al．NCCN clinical practice guidelines in oncology：palliative care（2020.V1）［EB/OL］．（2020-02-07）［2020-09-16］．https：//www.nccn.org/default.aspx.

［97］WHITE P，WHITE S，EDMONDS P，et al．Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease：a prospective community survey［J］．Br J Gen Pract，2011，61（587）：e362-370．DOI：10.3399/bjgp11X578043.

［98］BLINDERMAN C D，HOMEL P，BILLINGS J A，et al．Symptom distress and quality of life in patients with advanced congestive heart failure［J］．J Pain Symptom Manage，2008，35（6）：594-603．DOI：10.1016/j.jpainsymman.2007.06.007.

［99］高榕茂，湛晓勤.阿片类药物治疗慢性阻塞性肺疾病伴难治性呼吸困难的研究进展［J］．实用心脑肺血管病杂志，2015，23（6）：1-3．DOI：10.3969/j.issn.1008-5971.2015.06.001.

GAO R M，ZHAN X Q.Progress on opioids in treating refractory dyspnea in patients with chronic obstructive pulmonary disease［J］．Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2015，23（6）：1-3．DOI：10.3969/j.issn.1008-5971.2015.06.001.

［100］韩娜，于世英，褚倩.安宁疗护的核心症状和常用药物［J］．医学与哲学：2018，39（4）：10-13．DOI：10.12014/j.issn.1002-0772.2018.04b.03.

HAN N，YU S Y，CHU Q.The core symptoms and commonly used drugs of hospice care［J］．Medicine & Philosophy（B），2018，39（4）：10-13．DOI：10.12014/j.issn.1002-0772.2018.04b.03.

［101］WILDIERS H，MENTEN J.Death rattle：prevalence，prevention and treatment［J］．J Pain Symptom Manage，2002，23（4）：310-317．DOI：10.1016/s0885-3924（01）00421-3.

［102］LOKKER M E，VAN ZUYLEN L，VAN DER RIJT C C，et al．Prevalence，impact，and treatment of death rattle：a systematic review［J］．J Pain Symptom Manag，2014，47（1）：105-122．DOI：10.1016/j.jpainsymman.2013.03.011.

［103］BACK I N，JENKINS K，BLOWER A，et al．A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle［J］．Palliat Med，2001，15（4）：329-336．DOI：10.1191/026921601678320313.

［104］HUGHES A，WILCOCK A，CORCORAN R，et al．Audit of three antimuscarinic drugs for managing retained secretions［J］．Palliat Med，2000，14（3）：221-222．DOI：10.1191/026921600670188257.

［105］WILDIERS H，DHAENEKINT C，DEMEULENAERE P，et al．Atropine，hyoscine butylbromide，or scopolamine are equally effective for the treatment of death rattle in terminal care［J］．J Pain Symptom Manage，2009，38（1）：124-133．DOI：10.1016/j.jpainsymman.2008.07.007.

［106］OLSEN A K，SJØGREN P.Oral glycopyrrolate alleviates drooling in a patient with tongue cancer［J］．J Pain Symptom Manage，1999，18（4）：300-302．DOI：10.1016/s0885-3924（99）00080-9.

［107］中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南（2015）［J］．中华结核和呼吸杂志，2016，39（5）：323-354．DOI：10.3760/cma.j.issn.1001-0939.2016.05.003.

［108］EDMONDS P，KARLSEN S，KHAN S et al．A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer［J］．Palliat Med，2001，15（4）：287-295．DOI：10.1191/026921601678320278.

［109］WEE B，BROWNING J，ADAMS A，et al．Management of chronic cough in patients receiving palliative care：review of evidence and recommendations by a task group of the Association for Palliative Medicine of Great Britain and Ireland［J］．Palliat Med，2012，26（6）：780-787．DOI：10.1177/0269216311423793.

［110］ZENG Z，YANG D，HUANG X L，et al．Effect of carbocisteine on patients with COPD：a systematic review and meta-analysis［J］．Int J Chron Obstruct Pulmon Dis，2017，12：2277-2283．DOI：10.2147/COPD.S140603.

［111］王辰，王建安.内科学（上册）［M］．3版.北京：人民卫生出版社，2016.

［112］HOLLEN P J，GRALLA R J，KRIS M G，et al．Normative data and trends in quality of life from the Lung Cancer Symptom Scale（LCSS）［J］．Support Care Cancer，1999，7（3）：140-148．DOI 10.1007/s005209900016.

［113］KVALE P A，SIMOFF M，PRAKASH U B S.Lung cancer.Palliative care［J］．Chest，2003，123（1 Suppl）：284S-311S．DOI：10.1378/chest.123.1_suppl.284s.

［114］HANKERSON M J，RAFFETTO B，MALLON W K，et al．Nebulized tranexamic acid as a noninvasive therapy for cancer-related hemoptysis［J］．J Palliat Med，2015，18（12）：1060-1062．DOI：10.1089/jpm.2015.0167.

［115］MOEN C A，BURRELL A，DUNNING J.Does tranexamic acid stop haemoptysis？［J］．Interact Cardiovasc Thorac Surg，2013，17（6）：991-994．DOI：10.1093/icvts/ivt383.

［116］北京医师协会呼吸内科专科医师分会咯血诊治专家共识编写组.咯血诊治专家共识［J］．中国呼吸与危重监护杂志，2020，19（1）：1-11．DOI：10.7507/1671-6205.201911006.

［117］DAVIES A，BAGG J，LAVERTY D，et al．Salivary gland dysfunction（‘dry mouth'）in patients with cancer：a consensus statement［J］．Eur J Cancer Care（Engl），2010，19（2）：172-177．DOI：10.1111/j.1365-2354.2009.01081.x.

［118］JOBBINS J，BAGG J，FINLAY I G，et al．Oral and dental disease in terminally ill cancer patients［J］．BMJ，1992，304（6842）：1612．DOI：10.1136/bmj.304.6842.1612.

［119］SHIP J A，PILLEMER S R，BAUM B J.Xerostomia and the geriatric patient［J］．J Am Geriatr Soc，2002，50（3）：535-543．DOI：10.1046/j.1532-5415.2002.50123.x.

［120］NIKLES J，MITCHELL G K，HARDY J，et al．Testing pilocarpine drops for dry mouth in advanced cancer using n-of-1 trials：a feasibility study［J］．Palliat Med，2015，29（10）：967-974．DOI：10.1177/0269216315585473.

［121］CHENG C Q，XU H，LIU L，et al．Efficacy and safety of pilocarpine for radiation-induced xerostomia in patients with head and neck cancer：a systematic review and meta-analysis［J］．J Am Dent Assoc，2016，147（4）：236-243．DOI：10.1016/j.adaj.2015.09.014.

［122］RODRIGUEZ K L，HANLON J T，PERERA S，et al．A cross-sectional analysis of the prevalence of undertreatment of nonpain symptoms and factors associated with undertreatment in older nursing home hospice/palliative care patients［J］．Am J Geriatr Pharmacother，2010，8（3）：225-232．DOI：10.1016/j.amjopharm.2010.05.002.

［123］HALAWI R，ALDIN E S，BAYDOUN A，et al．Physical symptom profile for adult cancer inpatients at a Lebanese cancer unit［J］．Eur J Intern Med，2012，23（8）：e185-189．DOI：10.1016/j.ejim.2012.08.018.

［124］GLARE P，MILLER J，NIKOLOVA T，et al．Treating nausea and vomiting in palliative care：a review［J］．Clin Interv Aging，2011，6：243-259．DOI：10.2147/CIA.S13109.

［125］GLARE P，PEREIRA G，KRISTJANSON L J，et al．Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer［J］．Support Care Cancer，2004，12（6）：432-440．DOI：10.1007/s00520-004-0629-y.

［126］DAVIS M P，HALLERBERG G，Palliative Medicine Study Group of the Multinational Association of Supportive Care in Cancer.A systematic review of the treatment of nausea and/or vomiting in cancer unrelated to chemotherapy or radiation［J］．J Pain Symptom Manage，2010，39（4）：756-767．DOI：10.1016/j.jpainsymman.2009.08.010.

［127］MARTY M，POUILLART P，SCHOLL S，et al．Comparison of the 5-hydroxytryptamine3（serotonin）antagonist ondansetron（gr 38032F）with high-dose metoclopramide in the control of cisplatin-induced emesis［J］．N Engl J Med，1990，322（12）：816-821．DOI：10.1056/nejm199003223221205.

［128］中国抗癌协会癌症康复与姑息治疗专业委员会，中国临床肿瘤学会抗肿瘤药物安全管理专家委员会.肿瘤治疗相关呕吐防治指南（2014版）［J］．临床肿瘤学杂志，2014，19（3）：263-273.

［129］SOLANO J P，GOMES B，HIGGINSON I J.A comparison of symptom prevalence in far advanced cancer，AIDS，heart disease，chronic obstructive pulmonary disease and renal disease［J］．J Pain Symptom Manage，2006，31（1）：58-69．DOI：10.1016/j.jpainsymman.2005.06.007.

［130］RUIZ G V，LÓPEZ-BRIZ E，CARBONELL S R，et al．Megestrol acetate for treatment of anorexia-cachexia syndrome［J］．Cochrane Database Syst Rev，2013，2013（3）：CD004310．DOI：10.1002/14651858.CD004310.pub3.

［131］PASCUAL LÓPEZ A，ROQUÉ I FIGULS M，URRÚTIA CUCHI G，et al．Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome［J］．J Pain Symptom Manage，2004，27（4）：360-369．DOI：10.1016/j.jpainsymman.2003.09.007.

［132］NAVARI R M，BRENNER M C.Treatment of cancer-related anorexia with olanzapine and megestrol acetate：a randomized trial［J］．Support Care Cancer，2010，18（8）：951-956．DOI：10.1007/s00520-009-0739-7.

［133］JATOI A，WINDSCHITL H E，LOPRINZI C L，et al．Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia：a North Central Cancer Treatment Group study［J］．J Clin Oncol，2002，20（2）：567-573．DOI：10.1200/JCO.2002.20.2.567.

［134］DY S M，LORENZ K A，NAEIM A，et al．Evidence-based recommendations for cancer fatigue，anorexia，depression，and dyspnea［J］．J Clin Oncol，2008，26（23）：3886-3895．DOI：10.1200/JCO.2007.15.9525.

［135］CERCHIETTI L C，NAVIGANTE A H，PELUFFO G D，et al．Effects of celecoxib，medroxyprogesterone，and dietary intervention on systemic syndromes in patients with advanced lung adenocarcinoma：a pilot study［J］．J Pain Symptom Manage，2004，27（1）：85-95．DOI：10.1016/j.jpainsymman.2003.05.010.

［136］辛泽丽，郝晓莹，刘建立.性激素治疗与静脉血栓形成［J］．临床医药实践，2018，27（3）：213-216．DOI：10.16047/j.cnki.cn14-1300/r.2018.03.021.

［137］钱春艳，蔡小军，宋惠珠，等．肺癌患者化疗后应用甲地孕酮致深静脉血栓治疗的分析与探讨［J］．中国医院药学杂志，2016，36（5）：404-406．DOI：10.13286/j.cnki.chinhosppharmacyj.2016.05.17.

QIAN C Y，CAI X J，SONG H Z，et al．Analysis and discussion on deep vein thrombosis induced by megestrol acetate dispersible tablets in a lung cancer patient［J］．Chinese Journal of Hospital Pharmacy，2016，36（5）：404-406．DOI：10.13286/j.cnki.chinhosppharmacyj.2016.05.17.

［138］于世英，王杰军，王金万，等．晚期癌症患者合并肠梗阻治疗的专家共识［J］．中华肿瘤杂志，2007，29（8）：637-640．DOI：10.3760/j.issn：0253-3766.2007.08.021.

YU S Y，WANG J J，WANG J W，et al．Consensus of experts on the management of malignant bowel obstruction in patients with advanced cancer［J］．Chinese Journal of Oncology，2007，29（8）：637-640．DOI：10.3760/j.issn：0253-3766.2007.08.021.

［139］MERCADANTE S，CASUCCIO A，MANGIONE S.Medical treatment for inoperable malignant bowel obstruction：a qualitative systematic review［J］．J Pain Symptom Manag，2007，33（2）：217-223．DOI：10.1016/j.jpainsymman.2006.06.014.

［140］RIPAMONTI C，MERCADANTE S.Pathophysiology and management of malignant bowel obstruction［M］//DOYLE D，HANKS GW，MCDONALD N，et al．Oxford textbook of palliative medicine.3rd ed.New York：Oxford University Press，2005：496-506.

［141］LEGENDRE H，VANHUYSE F，CAROLI-BOSC F X，et al．Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction［J］．Eur J Surg Oncol EJSO，2001，27（4）：364-367．DOI：10.1053/ejso.2001.1120.

［142］ZELEK L，LAVAL G，ASSELAIN B.Somatostatin analogs for malignant bowel obstruction resulting from peritoneal carcinomatosis［J］．J Clin Oncol，2013，31（19）：2519-2520．DOI：10.1200/jco.2012.48.4634.

［143］MCCAFFREY N，ASSER T，FAZEKAS B，et al．Health-related quality of life in patients with inoperable malignant bowel obstruction：secondary outcome from a double-blind，parallel，placebo-controlled randomised trial of octreotide［J］．BMC Cancer，2020，20（1）：1050．DOI：10.1186/s12885-020-07549-y.

［144］RIPAMONTI C，MERCADANTE S，GROFF L，et al．Role of octreotide，scopolamine butylbromide，and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes：a prospective randomized trial［J］．J Pain Symptom Manage，2000，19（1）：23-34．DOI：10.1016/s0885-3924（99）00147-5.

［145］PORZIO G，AIELLI F，VERNA L，et al．Can malignant bowel obstruction in advanced cancer patients be treated at home？［J］．Support Care Cancer，2011，19（3）：431-433．DOI：10.1007/s00520-010-1009-4.

［146］MERCADANTE S，FERRERA P，VILLARI P，et al．Aggressive pharmacological treatment for reversing malignant bowel obstruction［J］．J Pain Symptom Manage，2004，28（4）：412-416．DOI：10.1016/j.jpainsymman.2004.01.007.

［147］FEUER D J，BROADLEY K E.Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer［J］．Cochrane Database Syst Rev，2000，2000（2）：CD001219．DOI：10.1002/14651858.CD001219.

［148］RIPAMONTI C I，EASSON A M，GERDES H.Management of malignant bowel obstruction［J］．Eur J Cancer，2008，44（8）：1105-1115．DOI：10.1016/j.ejca.2008.02.028.

［149］HUNT R，QUIGLEY E，ABBAS Z，et al．Coping with common gastrointestinal symptoms in the community：a global perspective on heartburn，constipation，bloating，and abdominal pain/discomfort May 2013［J］．J Clin Gastroenterol，2014，48（7）：567-578．DOI：10.1097/MCG.0000000000000141.

［150］LONDON S W.Adult palliative care guidance（2006）［EB/OL］．（2006-09）［2020-09-18］．http：//xueshu.baidu.com/usercenter/paper/show？paperid=43cf700d570c0e4203b24a583dd8cbbc&site=xueshu_se.

［151］BENSON A B，AJANI J A，CATALANO R B，et al．Recommended guidelines for the treatment of cancer treatment-induced diarrhea［J］．J Clin Oncol，2004，22（14）：2918-2926．DOI：10.1200/JCO.2004.04.132.

［152］ANDREYEV J，ROSS P，DONNELLAN C，et al．Guidance on the management of diarrhoea during cancer chemotherapy［J］．Lancet Oncol，2014，15（10）：e447-460．DOI：10.1016/S1470-2045（14）70006-3.

［153］MUEHLBAUER P M，THORPE D，DAVIS A，et al．Putting evidence into practice：evidence-based interventions to prevent，manage，and treat chemotherapy- and radiotherapy-induced diarrhea［J］．Clin J Oncol Nurs，2009，13（3）：336-341．DOI：10.1188/09.CJON.336-341.

［154］PESSI M A，ZILEMBO N，HASPINGER E R，et al．Targeted therapy-induced diarrhea：a review of the literature［J］．Crit Rev Oncol Hematol，2014，90（2）：165-179．DOI：10.1016/j.critrevonc.2013.11.008.

［155］CHERNY N I.Evaluation and management of treatment-related diarrhea in patients with advanced cancer：a review［J］．J Pain Symptom Manag，2008，36（4）：413-423．DOI：10.1016/j.jpainsymman.2007.10.007.

［156］中华医学会消化病学分会胃肠动力学组，中华医学会消化病学分会功能性胃肠病协作组.中国慢性便秘专家共识意见（2019，广州）［J］．中华消化杂志，2019，39（9）：577-598．DOI：10.3760/cma.j.issn.0254-1432.2019.09.001.

［157］STRASSELS S A，MAXWELL T L，IYER S.Constipation in persons receiving hospice care［J］．J Pain Symptom Manage，2010，40（6）：810-820．DOI：10.1016/j.jpainsymman.2010.03.018.

［158］WALSH D，DONNELLY S，RYBICKI L.The symptoms of advanced cancer：relationship to age，gender，and performance status in 1，000 patients［J］．Support Care Cancer，2000，8（3）：175-179．DOI：10.1007/s005209900128.

［159］ADDINGTON-HALL J M，MACDONALD L D，ANDERSON H R，et al．Dying from cancer：the views of bereaved family and friends about the experiences of terminally ill patients［J］．Palliat Med，1991，5（3）：207-214．DOI：10.1177/026921639100500305.

［160］国家药典委员会.中华人民共和国药典临床用药须知（中药饮片卷）：2015年版［M］．北京：中国医药科技出版社，2017.

［161］LARKIN P J，SYKES N P，CENTENO C，et al．The management of constipation in palliative care：clinical practice recommendations［J］．Palliat Med，2008，22（7）：796-807．DOI：10.1177/0269216308096908.

［162］LIBRACH S L，BOUVETTE M，DE ANGELIS C，et al．Consensus recommendations for the management of constipation in patients with advanced，progressive illness［J］．J Pain Symptom Manag，2010，40（5）：761-773．DOI：10.1016/j.jpainsymman.2010.03.026.

［163］KRAG M，PERNER A，WETTERSLEV J，et al．Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients［J］．Intensive Care Med，2015，41（5）：833-845．DOI：10.1007/s00134-015-3725-1.

［164］PEREIRA J，PHAN T.Management of bleeding in patients with advanced cancer［J］．Oncologist，2004，9（5）：561-570．DOI：10.1634/theoncologist.9-5-561.

［165］SOOD R，MANCINETTI M，BETTICHER D，et al．Management of bleeding in palliative care patients in the general internal medicine ward：a systematic review［J］．Ann Med Surg（Lond），2020，50：14-23．DOI：10.1016/j.amsu.2019.12.002.

［166］MCELLIGOTT E，QUIGLEY C，HANKS G W.Tranexamic acid and rectal bleeding［J］．Lancet，1991，337（8738）：431．DOI：10.1016/0140-6736（91）91211-c.

［167］HARRIS D G，NOBLE S I.Management of terminal hemorrhage in patients with advanced cancer：a systematic literature review［J］．J Pain Symptom Manage，2009，38（6）：913-927．DOI：10.1016/j.jpainsymman.2009.04.027.

［168］于普林.老年医学［M］．2版.北京：人民卫生出版社，2017.

［169］LEE C Y，CHEN L K，LO Y K，et al．Urinary incontinence：an under-recognized risk factor for falls among elderly dementia patients［J］．Neurourol Urodyn，2011，30（7）：1286-1290．DOI：10.1002/nau.21044.

［170］XU D，HAN S，WANG J，et al．Relationship between lower urinary tract dysfunction and clinical features in Chinese parkinson's disease patients［J］．Parkinsons Dis，2019，2019：6820937．DOI：10.1155/2019/6820937.

［171］卢启海，莫晓东，那万里.膀胱过度活动症的诊治现状和进展［J］．海南医学，2020，31（11）：1472-1476.

LU Q H，MO X D，NA W L.Status and progress of diagnosis and treatment of overactive bladder［J］．Hainan Medical Journal，2020，31（11）：1472-1476.

［172］WALTON A.Managing overactive bladder symptoms in a palliative care setting［J］．J Palliat Med，2014，17（1）：118-121．DOI：10.1089/jpm.2012.0116.

［173］PETERSON L M，REED H S.Hematuria［J］．Prim Care，2019，46（2）：265-273．DOI：10.1016/j.pop.2019.02.008.

［174］RAMIREZ D，GUPTA A，CANTER D，et al．Microscopic haematuria at time of diagnosis is associated with lower disease stage in patients with newly diagnosed bladder cancer［J］．BJU Int，2016，117（5）：783-786．DOI：10.1111/bju.13345.

［175］PAGE M S，BERGER A M，JOHNSON L B.Putting evidence into practice：evidence-based interventions for sleep-wake disturbances［J］．Clin J Oncol Nurs，2006，10（6）：753-767．DOI：10.1188/06.cjon.753-767.

［176］MERCADANTE S，AIELLI F，ADILE C，et al．Sleep disturbances in patients with advanced cancer in different palliative care settings［J］．J Pain Symptom Manage，2015，50（6）：786-792．DOI：10.1016/j.jpainsymman.2015.06.018.

［177］TAYLOR D J，MALLORY L J，LICHSTEIN K L，et al．Comorbidity of chronic insomnia with medical problems［J］．Sleep，2007，30（2）：213-218．DOI：10.1093/sleep/30.2.213.

［178］BERGER A M，PARKER K P，YOUNG-MCCAUGHAN S，et al．Sleep/wake disturbances in people with cancer and their caregivers：state of the science［J］．Oncol Nurs Forum，2005，32（6）：E98-126．DOI：10.1188/05.onf.e98-e126.

［179］KOZLOV E，PHONGTANKUEL V，PRIGERSON H，et al．Prevalence，severity，and correlates of symptoms of anxiety and depression at the very end of life［J］．J Pain Symptom Manag，2019，58（1）：80-85．DOI：10.1016/j.jpainsymman.2019.04.012.

［180］DELGADO-GUAY M，PARSONS H A，LI Z，et al．Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting［J］．Support Care Cancer，2009，17（5）：573-579．DOI：10.1007/s00520-008-0529-7.

［181］National Clinical Guideline Centre.Care of Dying Adults in the Last Days of Life［EB/OL］．（2015-12-16）［2020-09-18］．https：//pubmed.ncbi.nlm.nih.gov/26741019/.

［182］COCKS H，AH-SEE K，CAPEL M，et al．Palliative and supportive care in head and neck cancer：United Kingdom National Multidisciplinary Guidelines［J］．J Laryngol Otol，2016，130（S2）：S198-207．DOI：10.1017/S0022215116000633.

［183］LINDQVIST O，LUNDQUIST G，DICKMAN A，et al．Four essential drugs needed for quality care of the dying：a Delphi-study based international expert consensus opinion［J］．J Palliat Med，2013，16（1）：38-43．DOI：10.1089/jpm.2012.0205.

［184］李凌江，马辛.中国抑郁障碍防治指南［M］．2版.北京：中华医学电子音像出版社，2015.

［185］中华医学会精神医学分会老年精神医学组.老年期抑郁障碍诊疗专家共识［J］．中华精神科杂志，2017，50（5）：329-334．DOI：10.3760/cma.j.issn.1006-7884.2017.05.003.

［186］BC GUIDELINES.CA.Palliative care for the patient with incurable cancer or advanced disease part 2：pain and symptom management［EB/OL］．（2017-02-22）［2020-09-19］．https：//www.virtualhospice.ca/Assets/palliative2_20170506104831.pdf.

［187］FISCH M J，LOEHRER P J，KRISTELLER J，et al．Fluoxetine versus placebo in advanced cancer outpatients：a double-blinded trial of the Hoosier Oncology Group［J］．J Clin Oncol，2003，21（10）：1937-1943．DOI：10.1200/jco.2003.08.025.

［188］中华医学会精神医学分会抑郁障碍研究协作组.抑郁症认知症状评估与干预专家共识［J］．中华精神科杂志，2020，53（5）：369-376．DOI：10.3760/cma.j.cn113661-20200410-00177.

［189］MILLER K E，ADAMS S M，MILLER M M.Antidepressant medication use in palliative care［J］．Am J Hosp Palliat Care，2006，23（2）：127-133．DOI：10.1177/104990910602300210.

［190］KERR C W，DRAKE J，MILCH R A，et al．Effects of methylphenidate on fatigue and depression：a randomized，double-blind，placebo-controlled trial［J］．J Pain Symptom Manage，2012，43（1）：68-77．DOI：10.1016/j.jpainsymman.2011.03.026.

［191］万征，张慧.西酞普兰致QT间期延长的研究综述［J］．中国药事，2014，28（6）：641-645．DOI：10.16153/j.1002-7777.2014.06.021.

WAN Z，ZHANG H.Review on QT interval prolongation induced by citalopram［J］．Chinese Pharmaceutical Affairs，2014，28（6）：641-645．DOI：10.16153/j.1002-7777.2014.06.021.

［192］TOSUN TASAR P，SAHIN S，AKCAM N O，et al．Delirium is associated with increased mortality in the geriatric population［J］．Int J Psychiatry Clin Pract，2018，22（3）：200-205．DOI：10.1080/13651501.2017.1406955.

［193］HOSIE A，DAVIDSON P M，AGAR M，et al．Delirium prevalence，incidence，and implications for screening in specialist palliative care inpatient settings：a systematic review［J］．Palliat Med，2013，27（6）：486-498．DOI：10.1177/0269216312457214.

［194］LACASSE H，PERREAULT M M，WILLIAMSON D R.Systematic review of antipsychotics for the treatment of hospital-associated delirium in medically or surgically ill patients［J］．Ann Pharmacother，2006，40（11）：1966-1973．DOI：10.1345/aph.1H241.

［195］GROVER S，MATTOO S K，GUPTA N.Usefulness of atypical antipsychotics and choline esterase inhibitors in delirium：a review［J］．Pharmacopsychiatry，2011，44（2）：43-54．DOI：10.1055/s-0031-1273759.

［196］DAVIS M P.Does palliative sedation always relieve symptoms？［J］．J Palliat Med，2009，12（10）：875-877．DOI：10.1089/jpm.2009.0148.

［197］HASSELAAR J G，VERHAGEN S C，VISSERS K C.When cancer symptoms cannot be controlled：the role of palliative sedation［J］．Curr Opin Support Palliat Care，2009，3（1）：14-23．DOI：10.1097/SPC.0b013e3283260628.

［198］QUILL T E，LO B，BROCK D W，et al．Last-resort options for palliative sedation［J］．Ann Intern Med，2009，151（6）：421-424．DOI：10.7326/0003-4819-151-6-200909150-00007.

［199］MALTONI M，SCARPI E，ROSATI M，et al．Palliative sedation in end-of-life care and survival：a systematic review［J］．J Clin Oncol，2012，30（12）：1378-1383．DOI：10.1200/JCO.2011.37.3795.

［200］DE GRAEFF A，DEAN M.Palliative sedation therapy in the last weeks of life：a literature review and recommendations for standards［J］．J Palliat Med，2007，10（1）：67-85．DOI：10.1089/jpm.2006.0139.

［201］CHERNY N I，RADBRUCH L，The Board of the European Association for Palliative Care．European Association for Palliative Care（EAPC）recommended framework for the use of sedation in palliative care［J］．Palliat Med，2009，23（7）：581-593．DOI：10.1177/0269216309107024.

［202］AREVALO J J，BRINKKEMPER T，VAN DER HEIDE A，et al．Palliative sedation：reliability and validity of sedation scales［J］．J Pain Symptom Manage，2012，44（5）：704-714．DOI：10.1016/j.jpainsymman.2011.11.010.

［203］GARETTO F，CANCELLI F，ROSSI R，et al．Palliative sedation for the terminally ill patient［J］．CNS Drugs，2018，32（10）：951-961．DOI：10.1007/s40263-018-0576-7.

［204］朱依谆，殷明.药理学［M］．7版．北京：人民卫生出版社，2011．

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