臺北市立聯合醫院不施行心肺復甦術之急診病患流行病學

The Epidemiology of Do-not-resuscitate Orders in the Emergency Department of Taipei City Hospital

傅賓也(Ping-Yeh Fu) ； 林文允(Wen-Yun Lin) ； 趙國萍(Kuo-Ping Chao) ； 邱信瑋(Hsin-Wei Chiu) ； 陳志賢(Chih-Hsien Chen) ； 陳威廷(Wei-Ting Chen) ； 牟惕銘(Ti-Min Mou) ； 柴璽陸(Shi-Lu Chai) ； 黃永忠(Yung-Chung Huang) ； 賴昭智(Chao-Chih Lai) ； 璩大成(Da-Chen Chu) ； 黃勝堅(Sheng-Jean Huang)

《北市醫學雜誌》 13卷3期 (2016/09) Pp. 48-52

https://doi.org/10.6200/TCMJ.2016.13.3.06

摘要

目的：台灣自1980 年代起開始發展安寧療護，在2000 年通過安寧緩和條例。本研究主要調查在急診簽署不施行心肺復甦術同意書病人特性。方法：於北市聯合醫院仁愛院區，以回溯性蒐集自2015 年六月至2016 年五月的急診病人資料。結果：196 名於簽署DNR 的病患中，155 名非心搏停止狀況，41 名為心搏停止（包含院外或院內發生），平均年齡分別為84.8 與82.2 歲。非心搏停止中最常見的潛在疾病為癌症(31.6%)、失智症(36.1%)、腦中風(34.2%)等。無心搏停止的病人有68 名(43.9%) 於同次住院死亡，與同次住院無死亡比較，安寧緩和照護需求評估表分數具有顯著差異(p=0.019)。結論：目前急診簽署DNR 者，當中很多是中風或失智病患，為了落實預立醫療決定尊重病人自主權的精神，應設法讓病人在失能之前充分表達自己的意願。

關鍵字

不施行心肺復甦術 ； 生命末期照護 ； 安寧緩和需求評分 ； 到院前心跳停止

並列摘要

Objective: Hospice palliative care has been developed in Taiwan since 1980s. The Hospice Palliative Care Regulation was passed in 2000. This study was conducted to identify the clinical characters of patients with do not resuscitate (DNR) order in emergency department (ED). Methods: A retrospective study was conducted in the Taipei City Hospital, Renai branch from June 2015 to May 2016. Results: There were 155 non-cardiac arrest and 41 cardiac arrest (including out-of-hospital cardiac arrest and in-hospital cardiac arrest) patients among the 196 ED patients with do not resuscitate DNR order. The mean age of non-cardiac arrest and cardiac arrest patients were 84.8(11.8) and 82.2(12.9) years, respectively. The common underling diseases of the patients with DNR order with cardiac arrest were cancer (31.6%), dementia (36.1%), stroke (34.2%), etc. The most common underling diseases of the patients with DNR order without cardiac arrest were similar to those with cardiac arrest. Among the non-cardiac arrest patients with DNR order, 68 (43.9%) patients expired during hospitalization. The hospice eligibility score in patients who died during admission was significantly higher than those who survived (p=0.019). Conclusion: Many of the patients who visit ED suffer from stroke and/or dementia. The patients are usually unable to express themselves at the time when DNR order is to be implemented. In order to carry out the pre-order and respect patient's autonomy, they should be allowed to sufficiently express their wills before they loss their functions.

並列關鍵字

DNR ； do not resuscitate ； end-of-life care ； hospice eligibility score ； out-of-hospital cardiac arrest