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Journal of the Korean Academy of Family Medicine 1995;16(5):269-285.
Published online May 1, 1995.
Analysis of Terminal Care.
Myung Ho Hong, Youn Seon Choi
임종 진료에 관한 연구 - 말기 암환자의 통증 조절 -
홍명호, 최윤선
Abstract
Background
: The adequate and appropriate pain control for the terminal cancer patients which should have heen given is not simple matters to be accomplished. Because there was not enough accumulated experiences for the most of medical doctors through their residency training and they are not comfortable to give analgesics to terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patients, particularly narcotics.
Therefore the author attempt to make actual method to use in paractive with analyzing the requirement of analgesics, the method how th give analgesics, the side reaction from narcotic analgesics and the cahracteristics of terminally illed cancer patients in order to make a suggest how th approach to the terminally illed patient successfully.

Methods : A retrospective chart audit of analgesic type and amount was performed on the medical records of 100 terminal cancer patients who had been expired in the Holy Welfare Hospital from July 1991 through August 1993. Different typers and amounts of analgesics were converted to a common standard, and oral morphine equivalent(OME) relative to 1mg of oral morphine. Descriptive statistics were used to characterize patient analgesic use during the last 30 days and the last 5 days of life. Associations between analgesic use and select patient characteristics(age, sex, cancer site, metastasis, family life cycle, family type and pain intersity at the last 5 days of life) were explored.

Results : 1. The number of patients was 110, male, 60 cases(54.5%) and the female was 50 cases(45.5%) respectively.
2. 90% of 110 subjects had required analgesics to given at some time during terminal care. The 11 patients did not need any analgesics at all, 2 other patients did not need any analgesics during the last 5 days of life. However, 84.5% out of the all patients received narcotic analgesics at some time during the terminal course.
3. Most of the patients in this study used the long-acting form of oral morphine in regular basis and talwin was most frequently given alalgesics on an as-needed-basis. 61.7% of 99 subjects had been received analgesics by mouth during the last 30 days to the end of life and during the last 4 days, the requirement of pain killer by mouth had been decreased markedly to 54.6%. Parenteral and rectal route were prefered route of drug admistration as reach to the end of life.
4. The range of mean daily analgesics used was between 17.3 and 397.5 OMEs. The proportion of patients using analgesics increased while reach to death. The mean of daily requirement of analgesics longer than a month in duration was 73.6%mg(OME1) and the median was 58.0mg OMEs. During the last 5 days of life, the mean daily analgesic requirement was 79.5mg(OME2) and the midian was 61.5 OMEs. There was significant difference between OME1 and OME2(P<0.05).
5. OME2 was positively related with pain intensity at the last 5 days(P<0.05)/
6. OME2 was inversely related to age(r=-0.2978, P<0.01).
7. There were no statistically significant difference in OME2 by sex, staging, bone metastasis, family life cycle and family type.

Conclusion : The most of all terminally illed cancer patients acquired analgesics to take care of their terminal stage of life although there was some individual differences in the requirement of pain medication. Large and enormous doses of analgesics may sometimes be required to control cancer pain. To control apin properly was the one of important method th take care of terminally illed patient as breaking vicious cycle to pain-fear to death-depression, and preventing anxiety, hopelessness and give up dignity as a human being.
The side reactions from the analgesics ware not prominent as to avoid to give medication and those could be ignored.
초록
연구배경 : 말기 암환자가 호소하는 임상적 증상과 통증 조절을 위해 사용한 약물의 종류와 사용량을 조사함으로서 통증을 분석하고 치료하는데 익숙하도록 하고, 마약 중독이나 약물과용에 따르는 부작용에 대한 두려움과 오해에서 벗어나 계획적인 통증조절이란 임종진료의 목표를 달성하고자 본 연구를 시행했다.

방법 : 의식있는 상태로 입원하여 1991년 7월부터 1993년 8월까지 성가복지병원에서 사망한 암환자 110명을 대상으로 임상 기록지를 조사하여 다음과 같은 결과를 얻었다.

결과 : 사용된 진통제의 용량은 Oral morphine equivalent(이하 OME)라는 공통 단위로 환산해서 계산했다.
1mg 2/5mg 3mg 65mg
Oral Morphine=Morphine IM/SC=Oral Talwin


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