末期腎臟疾病的安寧緩和醫療

Palliative Care for End Stage Renal Disease

姚建安(Chien-An Yao) ； 邱泰源(Tai-Yuan Chiu) ； 陳慶餘(Ching-Yu Chen)

《安寧療護雜誌》 12卷3期 (2007/08) Pp. 321-331

https://doi.org/10.6537/TJHPC.2007.12(3).6

摘要

雖然透析治療技術不斷在進步，末期腎病人每年仍約有23%死亡率，伴隨同時發生的心血管、腦血管和周邊血管疾病常讓透析治療的生活成為折磨。這些病人需要更改良的症狀評估和控制，預立照顧計畫和高品質的緩和醫療。家屬需要在此艱困時期甚至其親人死後的支持。醫師需要富有經驗的疼痛和症狀處置和溝通技能的專業，以達成這些病人的眾多需求。這篇文章作文獻的回顧，並探討透析治療的預後，倫理和法律的考量，症狀處置和生命末期的議題。腎臟學的領域正從高度注重延長生命期轉移到更重視生活品質，有機會整合許多緩和醫療的進展到這些病人的全面性照護。

關鍵字

末期腎病 ； 緩和醫療 ； 透析治療 ； 生活品質

並列摘要

Despite ongoing technological advances, patients with end-stage renal disease (ESRD) have a mortality rate of approximately 23% per year, and comorbid cardiovascular, cerebrovascular, and peripheral vascular disorders often make life on dialysis an ordeal. This patient population needs an improved approach to symptom assessment and control, as well as advance care planning and high-quality palliative care. Families need support during the lifetime and after the death of their loved ones. Physicians need sophisticated expertise in pain and symptom management and skills in communication to meet the many needs of this population. This article reviews the literature and discusses prognosis, ethical and legal considerations, symptoms, treatment, and end-of-life issues. The field of nephrology is shifting from an exclusive focus on increasing survival to one that provides greater attention to quality of life. There is an opportunity to integrate many of the advances of palliative medicine into the comprehensive treatment of these patients.

並列關鍵字

end stage renal disease ； palliative care ； dialysis ； quality of life