呼吸困难影响了许多晚期癌症患者，临床指南推荐对于难治性呼吸困难的患者采用姑息镇静。目前，米达唑仑是最常用的镇静剂；然而，它可能引起严重的不良反应，如呼吸/循环抑制。因此，需要一种替代性的镇静剂。地西泮是一种有前途的替代性镇静剂，因其“清醒镇静”的效果；然而，在晚期呼吸困难患者中使用它的情况还很少知晓。因此，本研究的目的是确定DEX对于难治性呼吸困难的姑息镇静的安全性和有用性。本次回顾性研究包括了2018年1月至2022年10月期间，在临终关怀病房接受DEX姑息镇静的晚期癌症患者。我们通过成对t检验，分析了他们的一般数据、呼吸困难情况、镇静细节、镇静治疗效果、呼吸困难缓解以及麻醉前后生命体征的变化。我们纳入了17名接受DEX姑息镇静的晚期癌症患者，剂量为0.2-0.9 µg/kg·h，用于难治性呼吸困难的治疗，其中6人（35％）在10分钟内接受了1µg/kg的负荷剂量。在1小时的镇静和最大镇静剂量后，呼吸困难观察量表和里士满镇静-激动量表分数明显降低，与镇静前相比（所有P＜0.001），呼吸频率也降低了（分别为P=0.024和P=0.008）。心率和血氧饱和度未发生明显变化，而在镇静1小时后，收缩压和舒张压显著降低，低于镇静前（P=0.015）。地西泮是一种有前途的姑息镇静剂，可以安全地缓解难治性呼吸困难的症状，而不引起严重的不良反应。因此，DEX可以极大地提高晚期癌症患者的生活质量。 © 2023 Li等人。

Dyspnoea affects a considerable percentage of patients with terminal-stage cancer, and clinical guidelines recommend palliative sedation for patients with refractory dyspnoea. Midazolam is currently the most commonly used sedative; however, it can cause serious adverse reactions, such as respiratory/circulatory depression. Hence, there is a need for an alternative sedative. Dexmedetomidine (DEX) is a promising alternative as its "awake sedation" effect; however, little is known regarding its use in patients with end-stage dyspnoea. Therefore, the aim of this study was to determine the safety and usefulness of DEX for palliative sedation of patients with refractory dyspnoea.This retrospective study included patients with terminal-stage cancer who received DEX for palliative sedation owing to refractory dyspnoea in the hospice ward from January 2018 to October 2022. We analysed their general data, dyspnoea conditions, sedation details, sedative treatment effect, dyspnoea relief, and changes in vital signs before and after sedation, via paired t-tests.We included 17 patients with terminal-stage cancer who received DEX palliative sedation at a dose of 0.2-0.9 µg/kg·h for refractory dyspnoea, among whom 6 (35%) received a loading dose of 1 µg/kg in 10 min. After 1 h of sedation and at the maximum sedation dose, the Respiratory Distress Observation Scale and Richmond Agitation-Sedation Scale scores decreased significantly compared with those before sedation (all P<0.001), as did the respiratory rate (P=0.024 and P=0.008, respectively). The heart rate and blood oxygen saturation did not significantly change, whereas the systolic and diastolic blood pressure after 1 h of sedation were significantly lower than those before sedation (both P=0.015).DEX is a promising palliative sedative for patients with terminal-stage cancer, as it safely relieved the symptoms of refractory dyspnoea without inducing serious adverse reactions. Therefore, DEX may greatly enhance the quality of life for patients with terminal-stage cancer.© 2023 Li et al.