安寧療護中的搔癢處置

Management of Pruritus in Palliative Care

10.6537/TJHPC.2015.20(1).4

賴芳宇(Fang-Yu Lai)；蔡佩渝(Pei-Yu Tsai)；呂佳蓁(Chia-Chen Lu)

搔癢 ； 安寧療護 ； pruritus ； hospice care

安寧療護雜誌

20卷1期（2015 / 03 / 01）

36 - 53

繁體中文

搔癢是一種令人困擾的症狀，不少血液癌症病人併有搔癢，而在實體惡性腫瘤病人的慢性搔癢盛行率約為2%~11%。在某些非癌症疾病末期的病人，搔癢問題更是常見，例如慢性腎病、慢性肝病和肝硬化、愛滋病等等。搔癢可能造成病人焦慮憂心，甚至影響生活品質。然而引起搔癢的機轉複雜，目前仍未完全了解，針對不同機轉衍生不同的治療方式，如口服抗組織胺、抗憂鬱劑、鴉片類拮抗劑或促效劑、抗癲癇藥物、免疫調節劑、抗生素、膽酸結合劑、局部作用藥物和物理治療等等。上述治療方式的研究建議等級不高，但對於安寧療護病患多重因素相關或頑固型搔癢不失為治療選擇。本文介紹安寧療護中，非原發性皮膚疾病所致的搔癢盛行率、相關機轉、臨床表現，以及治療方式，供臨床照護參考。

Pruritus is a common and puzzling problem in hospice care patients. Many patients diagnosed with hematologic cancer have pruritus. The prevalence of chronic pruritus in patients with solid tumors is about 2% to 11%. In addition, pruritus is a common symptom of underlying diseases, such as chronic kidney disease, chronic liver disease with liver cirrhosis, and human immunodeficiency virus infection. It also has an impact on patient's mood and quality of life. The mechanism of pruritus is complex, and not fully understood. There are many therapeutic options, including antihistamines, antidepressants, opioid antagonists or agonists, anticonvulsants, immunomodulators, antibiotics, bile acid sequestrants, topical agents, and physical therapy. Although the evidences about these therapies used in hospice care are not high, these therapies are choices for pruritus caused by multiple factors or being resistant to other treatment. This article will introduce the prevalence, mechanisms, clinical manifestations, and management of secondary pruritus in hospice care patients.

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