協助末期慢性阻塞性肺部疾病患者撤除呼吸器：一個案報告

Withdraw Ventilator in End Stage Chronic Obstructive Pulmonary Disease: Case Report

陳琬青(Wan-Chin Chen) ； 蔡佩渝(Pei-Yu Tsai) ； 蘇育德(Yu-Tel Su)

《安寧療護雜誌》 13卷1期 (2008/02) Pp. 101-110

https://doi.org/10.6537/TJHPC.2008.13(1).8

摘要

慢性阻塞性肺部疾病在台灣四十歲以上成人，盛行率達16%，它目前是世界排名第四的死亡原因，且在未來數十年間的盛行率和死亡率還會持續上升。慢性阻塞性肺部疾病末期患者平均一年因肺疾惡化要住院三到四次，比肺癌患者有兩倍的機會會被送到加護病房治療，在生命的最後一年常常比肺癌患者有更多身體上或心理、社會層面被照護的需求，但卻常被排除在安寧緩和照顧之外。本文就臨床上協助一位慢性阻塞性肺部疾病末期患者撤除呼吸器的照護經驗在法律、倫理、情感上所面臨的問題和大家分享。

關鍵字

撤除 ； 維生治療 ； 慢性阻塞性肺病 ； 安寧療護

並列摘要

The prevalence of chronic obstructive pulmonary disease (COPD) in Taiwan is about 16% of the adult population aged 40 years and older. In the world, COPD is the fourth leading course of death. The trend of increasing prevalence and death rate of COPD is marked in the future. Patients with end-stage COPD are most likely to be admitted three to four times per year with exacerbations of COPD. Currently there is a lack of palliative care provision for patients with end-stage COPD compared with lung cancer patients despite having twice the odds of being admitted to an intensive care unit, poor prognosis, intolerable dyspnea, greater disability and poor quality of life. We share the experience of assisting a patient with end-stage COPD to withdraw ventilator in legal, ethical and emotional issues for reference to hospice palliative care team.

並列關鍵字

withdrawal ； life-sustaining treatment ； palliative care chronic obstructive ； pulmonary disease