居家癌症病人疼痛與譫妄之處理：案例討論

Management of Pain and Delirium in Cancer Patient at Home Care Setting: A Case Report

本個案為一名79歲之女性，經診斷罹患胰臟癌並合併有肺部轉移。考量到患者之年紀、疾病預後等多重因素，與患者及照顧家屬溝通後，決定轉由本院安寧緩和科進行居家照護。患者平日在家中由家屬自行照護，安寧緩和團隊的主治醫師和個案管理師會定期至患者家中進行評估和訪視，如有需要則立即給予醫療處置指示或藥品調整。本案於2015年4月開始收案至9月結案，期間經歷1次住院和共計13次之門診追蹤及居家訪視。主要評估問題為：胰臟癌造成之腹部疼痛和營養問題，給予鴉片類止痛藥品做疼痛控制，另外對於癌末患者出現之譫妄現象亦給予藥品作症狀緩解。本篇旨在討論癌末病人之疼痛控制，以及當病人併有譫妄症狀出現時，止痛藥品的調整和譫妄用藥。

A 79-years-old woman was diagnosed pancreatic cancer with lung metastasis. Considering about the patient's age and poor disease prognosis, she was transferred to palliative care team for home care after discussing with patient and her family. Under our home care, the patient stayed with her family, the attending physician and nurses visited the patient regularly and provided medical assessment and medication adjustment if needed. The courses of treatment started in April of 2015 and ended in September of 2015. There were one admission and thirteen ambulatory/home care visits. The main problems of the patient were abdominal pain and delirium that developed at the end of her life. Opioid analgesics were started for pain control before the hospital admission, and medications were prescribed for relieving delirium symptoms at her terminal stage of cancer. The issue of pain management in terminal cancer, adjustment of analgesia in patients with delirium symptoms, and pharmacotherapy of delirium are discussed in this article.