使用非侵襲性呼吸器（NIV）病人不施行心肺復甦術（DNR）之經驗分析

研究目的：探討使用非侵襲性呼吸器（NIV）病人不施行心肺復甦術（DNR）之經驗分析。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）住院病人使用非侵襲性呼吸器（NIV）個案中不施行心肺復甦術（DNR）之病人進行分析。結果：使用NIV病人有簽署DNR者共324位（佔37.6%），其中平均年齡以有簽署DNR此組77.8歲(SD=12.6)較未簽署DNR之68.9歲（SD=13.8）為高，p=0.003。在NIV 平均使用天數有簽署DNR為6.3天（SD=6.6）較未簽署DNR之4.3天（SD=4.7）為高，p＜0.001。比較其死亡率發現；有簽署DNR病人死亡率達54%，高於未簽署DNR之病人4.8%，p＜0.001。簽署DNR此組在使用NIV原因中以不予插管原因最多，共176位（佔54.3%）。加護病房平均住院天數中以有簽署DNR者之5.5天（SD=8.9）顯著低於未簽署DNR者之6.7天（SD=7.7），p=0.036。結論：使用NIV病人中有37.6%有簽署DNR，有簽署DNR病人在使用NIV的理由以不予插管佔54.3%，其NIV平均使用天數和死亡率也較高，因此建議醫療人員對於簽署DNR之病人使用NIV時必須考量優劣和審慎評估是否符合成本效益。

關鍵字

非侵襲性呼吸器；不施行心肺復甦術；不予插管；緩和醫療

並列摘要

Purpose: To analyze the experience of DNR of patients with NIV. Materials and methods: The research uses the retrospective inspection of electronic medical records to analyze the cases of DNR of the hospitalized patients with NIV from August 1st, 2013 to July 31st, 2015 (2 years in total) Result：The number of DNR patients with NIV totals 324 (37.6%), with an average age of 77.76 (SD=12.64), p=0.003 years old, significantly older than that of patients who have not signed DNR (68.94, SD=13.76). In regards to the length of hospitalization of patients with NIV, patients who have signed DNR average at 6.29 (SD=6.62) days in comparison to that of patient without DNR at 4.27 (SD=4.66) days, p ＜ 0.001. When comparing the mortality rates of the two groups, DNR patients have a higher rate of 54%, higher than that of patient without DNR at 4.8%, p ＜ 0.001. The main reason for patients, a total of 176 people, 54.3%, who have signed DNR to utilize NIV is their refusal of intubation, also known as Do Not Intubate (DNI). The length of the ICU stay of DNR patients at 5.46 (SD=8.89) days is significantly shorter than that of non-DNR patients who average 6.67 (SD=7.74) days, p=0.036. Conclusion: 37.6%. of patients with NIV have signed DNR. The main reason for DNR patients to use NIV is their refusal of having an endotracheal tube (176 people, 54.3%). In addition, the length of hospitalization and mortality rate is significantly longer and higher for DNR patients with NIV than non-DNR patients with NIV. For this reason, the study suggests that the medical personnel should take the advantages and disadvantages of using NIV on patients with and without DNR into consideration and carefully evaluate its cost-effectiveness.

並列關鍵字

Non-Invasive Ventilator (NIV) ； Do Not Resuscitate (DNR) ； Do Not Intubate (DNI) ； Palliative care Received:

參考文獻

黃麗續、魏書娥（2013）‧加護病房裡生命末期的醫療決策：以簽署不施行心肺復甦術意願（同意）書的決策分析為例‧生命教育研究，5（1），25-56。doi:10.3966/207466012013060501002

Azoulay, E., Kouatchet, A., Jaber, S., et al. (2013). Noninvasive mechanical ventilation in patients having declined tracheal intubation. Intensive Care Medicine, 39(2), 292-201. doi :10.1007/s00134-012-2746-2

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Corrêa, T.D., Sanches, P. R., de Morais LC, et al. (2015). Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study. BMC Pulmonary Medicine, 15, 1-8. doi:10.1186/s12890-015-0139-3

Corral-Gudino, L., Jorge-Sanchez, R. J., Garcia-Aparicio, J. et al. (2011). Use of noninvasive ventilation on internal wards for elderly patients with limitations to respiratory care: a cohort study. European Journal of Clinical Investigation, 4159-4169. doi:10.1111/j.1365-2362.2010.02380.x

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使用非侵襲性呼吸器（NIV）病人不施行心肺復甦術（DNR）之經驗分析

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