离死亡近期的3个月，肿瘤病人会显现8个信号
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“<span style="color: black;">每一个</span>人都是哭着来到这个世界，<span style="color: black;">期盼</span>走的那一刻，<span style="color: black;">能够</span>笑着离开。“</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">虽然<span style="color: black;">非常多</span>癌症<span style="color: black;">病人</span><span style="color: black;">能够</span><span style="color: black;">经过</span>积极治疗延长生命，但仍有一部分<span style="color: black;">病人</span>会<span style="color: black;">由于</span>恶化转向死亡。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">已然</span><span style="color: black;">处在</span>临终期，则<span style="color: black;">不该</span>该再过度治疗了，应该以<span style="color: black;">尽可能</span>减少遗憾、减少痛楚为目的，尊重<span style="color: black;">病人</span>的生命，使<span style="color: black;">病人</span>能平静、舒适、有尊严地走完人生的最后旅程。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-1e2d599e8f77eac08e92fa57545f73e0_720w.webp" style="width: 50%; margin-bottom: 20px;"></div><span style="color: black;">照片</span><span style="color: black;">源自</span>：摄图网<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">做好临终关怀不等于不孝，反而能让部分<span style="color: black;">病人</span>感受到<span style="color: black;">期盼</span>，<span style="color: black;">乃至</span>存活时间更长。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">科研</span><span style="color: black;">显示</span>，在死前转到了临终关怀医院的癌症<span style="color: black;">病人</span>，平均<span style="color: black;">存活</span>时间较<span style="color: black;">无</span>进行临终关怀的<span style="color: black;">病人</span>延长了29天之多。</p>2011年美国的一项<span style="color: black;">科研</span><span style="color: black;">表示</span>，<span style="color: black;">倘若</span>家属不得不为失去<span style="color: black;">认识</span>的<span style="color: black;">病人</span>做<span style="color: black;">要紧</span>的决定，就会对家属产生<span style="color: black;">极重</span>的<span style="color: black;">消极</span>影响，<span style="color: black;">包含</span>压力感、对自己所做决定的<span style="color: black;">愧疚</span>感、以及对自己<span style="color: black;">可否</span>做了正确决定的<span style="color: black;">可疑</span>。这种<span style="color: black;">消极</span>影响会<span style="color: black;">连续</span>数月，<span style="color: black;">乃至</span>数年之久。
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">说到底，<span style="color: black;">保持</span>治疗<span style="color: black;">亦</span>会<span style="color: black;">导致</span>痛苦，并且与来<span style="color: black;">自己</span>体的痛苦不同，治疗的痛苦源自于充满<span style="color: black;">期盼</span>到<span style="color: black;">期盼</span>破灭的绝望过程。从这<span style="color: black;">方向</span><span style="color: black;">来讲</span>，绝<span style="color: black;">不可</span>将谈论死亡视为“放弃<span style="color: black;">期盼</span>”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国人常说“回光返照”，在生命的最后一程，下面这些信号应该被留意，被温柔珍视。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">01 <span style="color: black;">病人</span><span style="color: black;">显现</span>中、重度<span style="color: black;">病痛</span></h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基本上所有晚期癌症<span style="color: black;">病人</span>都会<span style="color: black;">显现</span><span style="color: black;">病痛</span>，疼得厉害，并且是难以预测的“爆发式”<span style="color: black;">病痛</span>。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">02 <span style="color: black;">病人</span><span style="color: black;">显现</span>“回光返照”</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">“回光返照”是一种生理应激现象，常表现为某些状态和功能的<span style="color: black;">忽然</span>转变。<span style="color: black;">例如</span>，食欲<span style="color: black;">增多</span>；梦见已故的亲友；神志变得清醒，能开口说话了，思路清晰；精神亢奋等。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">03 <span style="color: black;">病人</span>的<span style="color: black;">认识</span><span style="color: black;">显现</span>改变</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">认识</span>按程度可分为清醒-嗜睡-<span style="color: black;">晕倒</span>，<span style="color: black;">认识</span>状态改变是临终<span style="color: black;">病人</span>的<span style="color: black;">平常</span>症状。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">04 <span style="color: black;">病人</span><span style="color: black;">显现</span><span style="color: black;">呼气</span>困难或<span style="color: black;">衰尽</span></h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">50%-70%的濒死<span style="color: black;">病人</span>会<span style="color: black;">显现</span><span style="color: black;">呼气</span>困难、喉鸣音、点头样的<span style="color: black;">呼气</span>。表现为呼气吸气费力，声音很大，<span style="color: black;">呼气</span>一口要停很长一段时间。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">05 <span style="color: black;">病人</span><span style="color: black;">显现</span>血压下降或体温改变</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症<span style="color: black;">病人</span>在临终<span style="color: black;">周期</span>常伴有循环系统的<span style="color: black;">衰尽</span>，表现为血压下降，降得很低很低；脸色苍白、发灰，肢体慢慢变凉；<span style="color: black;">非常多</span><span style="color: black;">病人</span>会<span style="color: black;">显现</span>肢体末梢皮肤的发紫。有的病人在最后几天会<span style="color: black;">显现</span>体温不升，一<span style="color: black;">起始</span>发热就烧到40度以上，<span style="color: black;">而后</span>慢慢下降，直到测不出来。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">06 <span style="color: black;">病人</span>仅能喝少量流质</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重点</span>表现为<span style="color: black;">膳食</span>喝水减少、恶心呕吐、便秘、尿量的改变。<span style="color: black;">病人</span>可能很久不<span style="color: black;">摄食</span>、不喝水，有的人<span style="color: black;">能够</span>十几天不吃不喝，直到去世。便秘<span style="color: black;">亦</span>很<span style="color: black;">平常</span>，大便很干，很久<span style="color: black;">无</span>一次。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">07 <span style="color: black;">病人</span><span style="color: black;">显现</span>卧床不起</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">绝大部分晚期癌症<span style="color: black;">病人</span><span style="color: black;">显现</span>器官<span style="color: black;">衰尽</span>，并伴有恶液质。心肺肾等功能都<span style="color: black;">欠好</span>，极度消瘦，乏力，精神萎靡，基本<span style="color: black;">始终</span>躺在床上一动一动，很少有能下床活动的。</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">08 <span style="color: black;">病人</span>用药方式改变</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">临终<span style="color: black;">周期</span>常改变平时的用药方式，以尽可能减少创伤，<span style="color: black;">例如</span><span style="color: black;">病痛</span>的时候用贴剂或肛门塞药。有<span style="color: black;">病人</span>水肿得厉害会打不进去针。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">临终关怀：指的是对进行性恶化或预计<span style="color: black;">存活</span>期较短的<span style="color: black;">病人</span>给予积极的整体护理，<span style="color: black;">掌控</span><span style="color: black;">病痛</span>及其他症状，<span style="color: black;">处理</span><span style="color: black;">要紧</span>的心理、社会和精神问题，<span style="color: black;">加强</span><span style="color: black;">病人</span>和家属的生活质量。<span style="color: black;">因此呢</span>，有效<span style="color: black;">掌控</span>症状，减轻<span style="color: black;">病人</span>痛苦，<span style="color: black;">加强</span><span style="color: black;">病人</span>舒适度是临终关怀的首要<span style="color: black;">措施</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">临终关怀<span style="color: black;">能够</span>怎么<span style="color: black;">这般</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、为<span style="color: black;">病人</span><span style="color: black;">供给</span>舒适的居住环境，<span style="color: black;">尽可能</span>避免嘈杂、脏乱。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、为<span style="color: black;">病人</span><span style="color: black;">供给</span>良好的<span style="color: black;">膳食</span>护理，照顾<span style="color: black;">病人</span>的个人<span style="color: black;">膳食</span>习惯，但要<span style="color: black;">尽可能</span>避免不健康<span style="color: black;">膳食</span><span style="color: black;">导致</span>病情恶化。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、为<span style="color: black;">病人</span>打理好个人卫生，<span style="color: black;">定时</span>换洗衣物、洗澡、剪指甲等，照顾好<span style="color: black;">病人</span>的生活质量和生命尊严。</p>4、安排好<span style="color: black;">病人</span>的<span style="color: black;">平常</span>生活，<span style="color: black;">例如</span>进行<span style="color: black;">一块</span>看电视、听音乐、聊天、散步等合适<span style="color: black;">病人</span><span style="color: black;">情况</span>的活动。
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尾声</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">生命的消亡，<span style="color: black;">每日</span>都在世界的某个<span style="color: black;">地区</span>上演，生命的新生，<span style="color: black;">一样</span><span style="color: black;">亦</span>是如此。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>死亡<span style="color: black;">没</span>法避免，那不如从<span style="color: black;">此刻</span><span style="color: black;">起始</span>学习温柔以待。当<span style="color: black;">咱们</span>理解了死亡，<span style="color: black;">亦</span>就找到了好好活着的<span style="color: black;">道理</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">等忙完这<span style="color: black;">一辈子</span>，<span style="color: black;">咱们</span>终将团聚。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">期盼</span>看见这篇<span style="color: black;">文案</span>的所有人，从今天<span style="color: black;">起始</span>，抽点时间，陪陪<span style="color: black;">哪些</span><span style="color: black;">咱们</span>爱的人，别让人生留下遗憾……</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考<span style="color: black;">源自</span>：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Dee Walker Ford, Kathryn A Koch, Daniel E Ray,et al. Palliative and End-of-Life Care in Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2013, 143(5 Suppl):e498S-512S.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Connor S R , Pyenson B , Fitch K , et al. Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window. J Pain Symptom Manage, 2007, 33(3):238-246.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Wendler D , Rid A . Systematic review: the effect on surro-gates of making treatment decisions for others . Ann Intern Med . 2011 ; 154 ( 5 ): 336 - 346.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">周茹珍, 王海霞, 周玲君, et al. 医护人员判断癌症<span style="color: black;">病人</span>濒死期的质性<span style="color: black;">科研</span>. 中华现代护理杂志, 2016, 22(3):301-304.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Pugh EJ, McEvoy M, Blenkinsopp J. Use of the proportion of patients dying on an End of Life Pathway as a quality marker: considerations for interpretation.Palliative Medicine,2010,24(5) 544–547.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Ruegger, Josh, Latchem, et al. Care of dying adults in the last days of life. Clinical medicine: journal of the Royal College of Physicians of London, 2016.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">杨洪菊，张静，唐欣元等. 肿瘤临床护理知识与技能. 天 津：天津科学技术出版社，2015：189.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">郭娜，我国临终关怀面临的问题及其对策.河北：河北师范大学，2014：11-12.</p>
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