- 期刊
醫療限制（不予心肺復甦術及不予截肢）：周邊動脈阻塞併心導管介入治療病人之分析
Limitations of Treatment-Examples of Do-not-Resuscitate & Do-not-amputate Orders: An Analysis on Patients with Peripheral Arterial Occlusion Disease Receiving Interventional Cardiac Catheterization
摘要
探討周邊動脈阻塞性疾病併心導管介入治療病人之醫療限制（treatment limitation）（不予心肺復甦術及不予截肢）現況。採電子病歷回溯性調查設計，以2013年1月1日至2019年12月31日（共7年）周邊動脈阻塞性疾病併心導管介入治療病人共397位進行分析。treatment limitation個案共39位（佔9.8%），其在年齡（77.3±11.4歲 vs. 71.9±11.4歲；P = 0.006）、此次住院中死亡（33.3% vs. 2.5%；P ＜ 0.001）、平均住院天數（16.2±13.8天vs. 6.7±8.7天；P ＜ 0.001）、心房顫動（35.9% vs. 10.6%；P ＜ 0.001）、缺血性中風（46.2% vs. 22.9%；P = 0.001）及白血球（11566.7±5052.1 uL vs. 8723.0±4373.9 uL；P ＜ 0.001）皆顯著高於無醫療限制（NO treatment limitation）之病人。但在白蛋白（3.0±0.6 mg/dl vs. 3.7±0.6 mg/dl；P ＜ 0.001）及血色素（10.3±2.1 g/dl vs. 11.0±2.0 g/dl；P = 0.023）等檢驗數據顯著低於NO treatment limitation之病人。周邊動脈阻塞心導管介入治療病人仍存有treatment limitation。treatment limitation之病人住院天數較長、共病、感染嚴重、營養差且死亡率高，因此提醒照護團隊此類病人潜在之風險，進而輔助臨床實施有效之醫病共享決策。本文研究結果提供醫護團隊決策上之參考。
並列摘要
The purpose of the study aims at exploring the current situations of Do-not-resuscitate (＂DNR＂) and Do-not-amputate (＂DNA＂) for patients with peripheral arterial occlusion disease (＂PAOD＂) receiving interventional cardiac catheterization (＂ICC＂). With a retrospective study framework involving electronic medical records, the study targets 397 patients with PAOD receiving ICC during the time frame between January 1, 2013 and December 31, 2019. 39 cases with treatment limitations, which account for 9.8% of the surveyed, show significantly higher statistics than those without when it comes to the following respective dimensions: 77.3±11.4 vs.71.9±11.4 in terms of age with P = 0.006; 33.3% vs. 2.5% in terms of death rate during hospitalization with P = 0.001; 16.2±13.8 vs. 6.7±8.7 in terms of days of hospitalization with P ＜ 0.001; 35.9% vs. 10.6% in terms of atrial fibrillation with P ＜ 0.001; 46.2% vs.22.9% in terms of ischemic stroke with P =0.001; 11566.7±5052.1 vs.8723.0±4373.9 in terms of white blood cell with P ＜ 0.001. However, the figures are lower for those with treatment limitations when it comes to albumin (P ＜0.001) and hemoglobin (P = 0.023): 3.0±0.6 and 10.3±2.1 for those with limitations respectively; 3.7±0.6 and 11.0±2.0 for their counterparts respectively. It is found that patients with PAOD receiving ICC still have treatment limitations. Those with such limitations tend to be hospitalized longer, characterized by comorbidity, severe infections, malnutrition, and higher mortality rate. The risks of taking care of such patients thus need to be kept in mind, which can further facilitate implementation of effective shared medical decision-making in clinical medicine. The study can be used as a reference on which medical decisions by health care professionals can be based.