運用安寧療護協助一位呼吸器依賴病人走完生命末期歷程

急重症病人在獲得良好的醫療照護後，病情穩定使用呼吸器者得以延長生命，但其中有31%無法順利脫離而成為呼吸器依賴患者。此類病人的預後並不理想，除了高住院率和高死亡率之外，生活自理能力逐漸降低、生活品質差，產生憂鬱、焦慮和低自尊等心理問題，甚至意識不清、肢體無法活動且僵硬，生活功能完全依賴照顧者；此外，冗長的住院天數造成醫療成本的消耗，同時也造成主要照顧者和家屬長期的經濟和身、心、社會壓力。本文為一呼吸器依賴之末期老人痴呆患者，經引用安寧療護條例的觀念，並積極給予氣道衛生處置和漸進性呼吸訓練，在最佳狀態時給予拔管脫離呼吸器，協助病人成功脫離呼吸器一段時日。在與家屬溝通後取得一致同意，之後再次發生呼吸衰竭時，便援引家屬簽署之「不施行心肺復甦同意書」，不再插管使用呼吸器，使病人得以善終，減輕病人和家屬的不必要的痛苦和負擔。期待此個案分享，對於日後照護此類病人有所幫助，且有助於安寧觀念的推廣。（安寧療護 2011：16：2：228-239）

關鍵字

呼吸器依賴；脫離呼吸器；安寧條例；安寧療護

並列摘要

As the advance in medical technology, critical patients with ventilator-support after good medical care, have became stable and are able to prolong their survival; but there is still an average of 31% critical patients could not be weaned and become long-term ventilator-dependent patients.The prognosis of ventilator-dependent patients is not ideal. There is a high rate of hospitalization and mortality for them, and decreased daily activities resulting in poor quality of life. As well as the majority of those patients will have depression, anxiety, low self-esteem and other psychological problems, and even unconsciousness, their limbs are rigid and physical activity are totally dependent. Moreover, the long hospital staying consumes many health care resources, but also results in economic, physical, psychological and social stresses on caregivers and families.Some of the patients have the chance of weaning from ventilators, but there are still risks of respiratory failure if extubated. If we help the patient to wean from ventilator in best condition, and then adopt the concept of hospice care opportunely, it can help these patients to reduce unnecessary suffering, but also their families the economic and multilateral loading, and even pass away with dignity and quality of life.We would like to introduce a case of end-stage senile dementia who had long-term intubated with ventilator support, after giving management of the airway hygiene and respiratory training, we tried to extubate, then the patient was weaned from ventilator successfully for 2 months. We also got an identical agreement with his family members, about the ”DNR” (Do Not Resuscitate) consent on the recurrence of respiratory failure for the patient. Therefore, the patient could be pass away naturally and peacefully, and his families could be relieved from much unnecessary suffering and burden. We shared this case for caring this kind of patients and promoting the concept of hospice care in the future. (Taiwan J Hosp Palliat Care 2011:16:2:228-239)

並列關鍵字

ventilator dependence ； weaning ； hospice regulations ； hospice care

國際替代計量

運用安寧療護協助一位呼吸器依賴病人走完生命末期歷程

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