- 期刊
癌末胃腸阻塞病人使用全靜脈營養後撤除時機的探討
When is the Appropriate Time to Withdraw TPN in Terminal Cancer Patients with Bowel Obstruction?
摘要
惡性腸阻塞是末期腹部腫瘤的併發症之一，它會造成病人的疼痛、噁心、嘔吐及無法進食等症狀。由於病人無法進食易造成家人心理的愧疚與不捨，因此有關病人的營養與水分的種種問題就成了討論的議題。本研究針對癌末病人合併有惡性腸阻塞在使用全靜脈營養(total parenteral nutrition: TPN)後，接受安寧居家護理的照顧，並與病人及家屬討論何時是撤除TPN的適當時機。 我們自95年5月到96年11月，共收集7個案例：3例胃癌、2例卵巢癌、1例直腸癌、1例肝癌，平均年齡56.9歲。使用TPN的原因皆因腫瘤引起腸阻塞而導致病人無法經口進食，除了一例是因肝癌造成胃出口阻塞。癌症診斷到往生時間平均約1年7個月（最短7.6個月，最長3年4個月）。使用TPN的時間平均是67.7天（最短14天，最長133天）。撤除TPN後到死亡的時間平均是8.9天（最長28天，最短1天）。 當病人的病情有急速惡化時（包括疾病本身的惡化，以及發生與使用TPN有關的嚴重併發症，例如：敗血性休克），此時會造成病人生命徵候的不穩定與意識不清，以及病人與家屬有明確意願表示不要繼續使用TPN時，應是撤除TPN的適宜時機。
並列摘要
Bowel obstruction is a common complication in patients with end-stage cancer, particularly in those with an abdominal or pelvic primary. Continuous abdominal pain, nausea, vomiting and dysphagia are the common clinical symptoms, and the latter will increase caregiver's psychological burden. Artificial nutrition and hydration for the advanced cancer patients is controversial, and also an ethical issue in the hospice. The purpose of this study is focusing on the timing of withdrawal of total perenteral nutrition (TPN) in advanced cancer patients with bowel obstruction, who received home TPN. Results: We collected 7 terminal cancer patients with malignant bowel obstruction (three gastric cancers, two ovary cancers, one rectal cancer and one hepatocellular carcinoma.) from May 2006 to November 2007. Patients received TPN due to malignant intestinal obstruction except one patient, who had gastric outlet obstruction due to compression by the hepatocellular carcinoma. Patients received TPN for a mean duration of 67.7 days (range from 14 to 133 days), and the mean survival after withdrawal of TPN is 8.9 days (range from 1 to 28 days). Conclusions: the appropriate timing to withdraw TPN, in this study, are sudden onset of disease exacerbation, septic shock associated with TPN, and the valid wish to withdraw TPN by patient and his or her family.