某區域醫院不予插管（DNI）病人使用非侵襲性呼吸器（NIV）之現況分析

Experience Analysis of DNI (Do No Intubation) Patients Using NIV (Non-Invasive Ventilator).

馬瑞菊(Jui-Chu Ma) ； 馬瑞萍(Jui-Ping Ma) ； 鄭佩玲(Pei-Ling Cheng) ； 張喬茹(Chiao-Ju Chang) ； 林佩璇(Pei-Xuan Lin) ； 蕭嘉瑩(Chia-Ying Hsiao) ； 蘇珉一(Min-I Su)

《安寧療護雜誌》 22卷1期 (2017/03) Pp. 13-26

https://doi.org/10.6537/TJHPC.2017.22(1).2

摘要

研究目的：探討不予插管(DNI)病人使用非侵襲性呼吸器(NIV)之現況分析。材料與方法：採電子病歷回溯性調查設計，以2013年8月1日至2015年7月31日(共2年)住院中不予插管(DNI)病人使用非侵襲性呼吸器(NIV)個案進行分析。結果：DNI病人共216位，平均年齡為77.22歲(SD = 13.13)、NIV平均使用天數為6.76天(SD = 6.99)、平均住院天數為16.9天(SD = 12.42)、加護病房平均住院天數為2.59天(SD = 5.54)、醫療支出平均為2756599.3(SD = 4458370.27)元。Standard treatment使用NIV病人共103位(佔47.69%)，Symptom relief使用NIV病人共113位(佔52.31%)，而DNI病人使用NIV後仍插管的比率以Standard treatment組顯著高於Symptom relief組(6.8% vs. 0.9%；p = 0.022)，死亡率以Symptom relief組顯著高於Standard treatment組(61.1% vs. 42.7%；p = 0.007)，Symptom relief組若有使用NIV之禁忌症如；病人意識不清者有72.5%(N = 50)死亡，血液動力學不穩者則有47.8%(N = 33)死亡。結論：不予插管(DNI)病人中約有五成病人是為了緩和醫療(Symptom relief)的目的而使用NIV，但較Standard treatment使用者死亡率顯著為高，而使用NIV有意識不清之禁忌症者其死亡率更高達七成，因此醫療人員在提供病人或家屬維生醫療抉擇時必須詳盡說明優劣，對於意識不清者更應謹慎使用。

關鍵字

不施行心肺復甦術 ； 不予插管 ； 非侵襲性呼吸器 ； 症狀緩解 ； 緩和醫療

並列摘要

Purpose: This analysis is to explore the experiences of DNI patients using NIV. Materials and methods: The survey of the analysis is designed by tracing back the electric medical record of DNI patients using NIV from August 1st 2013 to July 1st 2015. Results: There are totally 216 patients and their information are as follows: average age of 77.22 (SD = 13.13), 6.76 days (SD = 6.99) of using NIV, 16.9 days (SD = 12.42) of hospitalisation, 2.59 days (SD = 5.54) in ICU, and NT$3,301,752.06 spent (SD = 5277696.38) in medical care. There are 103 patients (47.69%) using NIV in Standard treatment whilst there are totally 113 patients (52.31%) using NIV in Symptom relief. The ratio that DNI patients require intubation after using NIV in group of Standard treatment is significantly higher than that in Symptom relief (6.8% vs. 0.9%; p = 0.022). The death ratio of Symptom relief is significantly higher than that of Standard treatment (61.1% vs. 42.7; p = 0.007). If there was disease not allowed to use NIV (e.g. unconsciousness) in the group Symptom relief, the death ratio would be 72.5%. And patients with unstable hemadynamics are of 47.8% death ratio (N = 33). Conclusion: Around 50% of DNI patients are using NIV for palliative care (Symptom relief), but the death ratio is significantly higher than that of Standard treatment. Patients using NIV as a result of inconvenient disease of unconsciousness are of 70% death ratio. Thus, when medical crew is offering patients or their family medical options, they must explain all pros and cons detail, especially for those in unconsciousness.

並列關鍵字

DNR(Do Not Resuscitate) ； DNI (Do not intubation) ； NIV(Non-invasive ventilator) ； Symptom relief ； Palliative care

參考文獻

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