某醫學中心安寧住院病人存活因子的比較

Comparison of Factors Influencing Survival or Death of Terminal Cancer Patients in a Medical Center

殷紹閔(Shio-Ming Yin) ； 邱鈺雯(Yu-Wen Chiu) ； 黃洽鑽(Chia-Tsuan Huang)

《臺灣家庭醫學研究》 7卷1期 (2009/01) Pp. 12-18

https://doi.org/10.29475/TFMR.200901.0002

摘要

背景：癌症末期患者的存活時間預測往往是影響安寧療護團隊醫療決策的關鍵，雖然過去少數文獻提出一些因素或量表可以作為預測存活期的參考，但適用性和準確度仍稍嫌不足，國內相關研究更是相對較少。所以本研究的目的是為了了解可能影響癌末患者死亡的因素，尤其是分析感染症是否為影響住在安寧療護病房癌末患者死亡的因素。
方法：本研究以病歷回顧的方式收集2005年3月至2006年1月南部某家醫學中心安寧緩和病房的218位住院個案為研究對象來進行分析。病歷收集的資料包括病史、住院天數、疼痛、呼吸困難、厭食、腹水、水腫、意識狀態是否改變（譫妄）、是否合併系統性感染症、病患當次住院是否死亡和當次住院存活且順利出院。
結果：本研究的218位病患當中，平均年齡是63.5±13.7歲，其中129位為男性。平均住院天數是11.0±10.7天。我們比較在當次住院時，影響死亡的因素在住院死亡和出院這兩組的差異，結果顯示性別、年齡、住院天數和多數的臨床症狀（包括疼痛、腹水、肋膜積水、水腫、憂鬱、食慾差、感染）在這兩組中並沒有顯著的差異，唯獨有差異的是呼吸困難(p=0.045)和意識狀態(p=0.002)改變，本研究中並未發現系統性感染與死亡的直接相關性。
結論：本研究發現，呼吸困難和意識狀態改變是影響癌症末期患者死亡之重要危險徵候，本研究結果與過去某些文獻呈現一致性。本研究提供安寧療護照顧者建議，若癌症末期病人出現呼吸困難或意識狀態改變，則有可能是死亡的前兆，給家屬或照顧團隊作為治療策略的參考。感染症在本研究中雖然被發現不是影響因素，然而樣本數侷限了本研究的統計顯著性，所以仍需要更多的研究來釐清。未來也期望有更多的研究來幫助建立更完整的預測指標，進而提升安寧照顧的品質。

並列摘要

Background: The prediction of the survival time in terminal cancer patients is important in palliative care. Though some prognostic scales related to terminal cancer patients have been published in literature, accurate and applicable predicting scales are still rare. The relevant study regarding predictors in hospices is also scarce in Taiwan. Therefore, to study the predisposing factors of death for terminal cancer patients, especially causing from infections, is urgent.
Method: This retrospective chart review study collected the data of 218 patients who were hospitalized in our hospice ward between March 2005 and January 2006. The available data included past history, hospitalization days, pain, dyspnea, poor appetite, ascites, edema, consciousness change (delirium), systemic infection, and expiration or survival during the period of hospitalization.
Result: Among our 218 subjects studied, there were 129 males, and the average patient age was 63.5±13.7 years. Mean hospitalization duration was 11.0±10.7 days. We compared the predisposing factors to death between expired cases and non-expired cases. There was no statistically significant difference between the 2 groups in gender, age, hospitalization days, or the most of the symptom of illness(including pain, ascites, pleural effusion, edema, poor appetite, and infection), except for dyspnea (p=0.045) and consciousness change (p=0.002). There was also no significant relationship between systemic infection and death in our study.
Conclusion: Our results are consistent with previous studies and demonstrate that dyspnea and consciousness change are two observable signs which may be of help in predicting the possibility of death in terminal cancer patients. This finding may help medical care providers to employ more suitable medical strategies. In our study, infection was not a predisposing factor to death. Further research with larger sample size may be warranted to clarify some revealing issues such as the relationship between infection and prognosis.

並列關鍵字

hospice ； infection ； palliative care ； prediction ； prognosis