巴拉刈中毒病人緩和醫療決策－十年趨勢分析

巴拉刈中毒病人之醫療處置十年區間探討，採電子病歷回溯性調查設計，以加護病房2008年7月至2018年6月中毒之個案進行分析，並以自擬結構性調查表進行資料收集。統計十年巴拉刈中毒病人共87人，院內死亡共61人（70.1%），死亡前24小時接受緩和鎮靜藥物（50.8%～100%）及嗎啡（31.2%～83.3%）之十年區間比較有顯著上升（p值＜0.001），接受醫療處置之十年區間比較在插管併呼吸器使用（44.3%～0% p值＜0.001）、化學藥物處置（70.5%～16.7% p值=0.025）、血管升壓劑（34.4%～16.7% p值=0.031）、強心藥物（29.5%～16.7% p值=0.006）及抗生素（18.0%～16.7% p值＜0.001）等皆有顯著下降，但在血液灌洗處置未見差異（80.3%～83.3% p值=0.462）。巴拉刈中毒病人近年來緩和醫療接受度逐年上升，且死亡前除血液灌洗外，其他維生醫療處置業已減少。因此建議除早期介入維生醫療處置討論外對於死亡前血液灌洗之必要性需再審慎評估。

關鍵字

巴拉刈中毒（Paraquat intoxication）；維生醫療（Life sustaining treatment）；緩和醫療（Palliative care）；血液灌洗（Hemoperfusion）

並列摘要

To explore medical treatment for patients with paraquat intoxication through a 10-year trend analysis. In this retrospective study, electronic medical records were used to analyze paraquat intoxication in patients admitted to intensive care units from July 2008 to June 2018. A self-designed structural survey was created for data collection. In total, 87 patients had paraquat intoxication in 10 years, and 61 (70.1%) of them died. A significant increase (P ＜ .001) in treatment with palliative sedation and morphine was observed for patients before death. A significant decrease was observed in treatment with mechanical ventilation (P ＜ .001), cyclophosphamide (P =.025), vasopressors (P =.031), inotropic agents (P =.006), and antibiotics (P ＜ .001), but no difference was noted in treatment with hemoperfusion (P = .462). Palliative care acceptance has increased year after year in patients with paraquat intoxication, and ineffective life sustaining treatment has been reduced; however, hemoperfusion is still applied to patients before death. In addition to early discussion of life sustaining treatment in patients with paraquat intoxication, the necessity of hemoperfusion before death should be carefully evaluated.

並列關鍵字

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巴拉刈中毒病人緩和醫療決策－十年趨勢分析

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