安寧療護使用抗生素的倫理考量：以接受腰大肌膿瘍治療病人為例

The Ethical Dilemma about Invasive Treatment for Terminal Illness Patient with Psoas Abscess

許喬琳(Chiao-Lin Hsua) ； 潘湘如(Hsiang-Ju Pan)

《安寧療護雜誌》 20卷2期 (2015/07) Pp. 177-185

https://doi.org/10.6537/TJHPC.2015.20(2).7

摘要

安寧療護的末期病人因為免疫功能低下，常常有併發感染的問題，但目前針對末期病人，因病況複雜度高，存活期難以準確預估，因病人病況不允許，許多侵入性檢查才能獲得的檢體幾乎無法取得，因此，是否需使用到後線抗生素之議題目前仍無定論。而針對一般內科病人感染腰大肌膿瘍，標準治療是積極使用抗生素以及膿瘍引流甚至手術治療，有時單純使用抗生素也沒有辦法解決整體症狀。然而，在緩和醫療中，光是針對腰大肌膿瘍採集檢體，就需多方考量此檢查方式以及後續治療對病人造成的負擔，副作用，醫療費用的付出，以及抗生素抗藥性增加的風險是否多過於對病人的好處，以及是否真能改善病人生活品質更是最關心之議題。除此之外，也需考量病人的生命期是否值得積極處理。因此，本文提出一位不明原因癌症合併多處器官轉移，且因腦部轉移而長期使用類固醇的高齡女性，經檢查後診斷為腰大肌膿瘍併沙門氏菌菌血症感染，後續使用後線抗生素合併引流治療腰大肌膿瘍的經驗及其相關倫理問題。本個案使用抗生素治療是有好的結果，但仍需累積更多類似個案經驗來支持。照顧癌末病人總會不斷面臨倫理困境的兩難抉擇，而治療的目的還是以是否能改善生活品質為主要依據。

關鍵字

腰大肌膿瘍 ； 非傷寒性沙門氏菌 ； 抗生素 ； 末期病人

並列摘要

Psoas abscess and lumbar osteomyelitis due to non-typhoid salmonella infection is very rare, although it is relatively frequent in immunocompromised patients. According to general treatment principle, which always resolved by medical treatment and percutaneous drainage of abscess. Nevertheless, whether antibiotic therapy or invasive drainage provides modest benefits for terminal cancer patients was uncertain. Here, we report a case of 73-year-old lady at terminal stage of malignancy of unknown origin that had non-typhoid Salmonellosis with psoas abscess and lumbar osteomyelitis. This was a challenge to our medical team members to communicate with the family about invasive evaluation and further treatment option. Fortunately, this patient got improvement after complete treatment and she satisfied about her symptoms. However, this is one case report, we need further studies to guide for antibiotic use in infected terminal cancer patients.

並列關鍵字

palliative care ； psoas muscle abscess ； non-typhoid Salmonella ； drain ； antibiotics

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