疫情之下的安寧療護介入──論台灣南部某醫學中心安寧介入之概況

Palliative care integration in the midst of Pandemic: Overview of palliative care in a southern Taiwan hospital

張彤(Tung Chang) ； 柯獻欽(Shian-Chin Ko)

《安寧療護雜誌》 27卷1期 (2023/03) Pp. 32-43

https://doi.org/10.6537/TJHPC.202303_27(1).03

摘要

背景：新型冠狀病毒肺炎（coronavirus disease 2019,COVID-19）流行期間，安寧療護的施行對於確保病人尊嚴及維護珍貴醫療資源，扮演重要的角色。然而，目前安寧療護介入新型冠狀病毒肺炎病人的時機及方式之相關研究，特別是亞洲國家，卻較為缺乏。目的：本研究探討確診COVID-19的病患接受安寧療護介入比例、方式及預測安寧療護介入的相關因子。方法：本篇採用回溯性研究，蒐集2021年01月01日至2022年09月30日之間的COVID-19確診成年病患，統計其人口變項學，安寧療護介入及醫療介入之間的關係。結果：總共蒐集1,086位成年病患（男性：53.8%），期間167人死亡，死亡率為15.4%。研究期間共528人接受安寧介入，占總樣本數的48.6%，其中在死亡的族群中高達96.4%的人口曾有安寧療護介入，介入方式以嗎啡給予為大宗，而平均安寧療護介入至死亡的時間為22.59天。能有效預測安寧介入的因子包含：年齡、性別、住院天數、共病症數及醫療介入數。結論：由上述人口變項學可得知年紀、性別、住院天數、共病症數及醫療介入數皆可有效預測安寧緩和介入因子，且共病症數及醫療介入數愈多，愈容易有安寧療護介入。

關鍵字

嚴重特殊傳染性肺炎（COVID-19） ； 安寧療護介入 ； 緩和療護

並列摘要

Background: During the COVID-19 pandemic, palliative care plays an important role in ensuring the dignity of patients and maintaining precious medical resources. However, there is currently a lack of research on the timing and methods of palliative care intervention for COVID-19 patients, especially in Asian countries. Aim: The aim of this study was to analyze the percentage and approaches of hospice care integrated during this pandemic from COVID-19 infected patients. Methods: This is a retrospective cohort study which collects COVID-19 diagnosed adult patients between January 1, 2021, and September 30, 2022. This study analyzes the relationship between demographic variables, palliative care interventions, and medical interventions. Results: A total of 1,086 adult patients (53.8% male) were collected, with 167 deaths during the period, resulting in a mortality rate of 15.4%. During the study period, a total of 528 individuals received palliative care interventions, which is 48.6% (n=528/1086) of the total sample size. Among the population who died, as many as 96.4% had received palliative care interventions, with morphine being the main intervention method. The average time from palliative care intervention to death was 22.59 days. Factors that could effectively predict palliative care interventions included age, gender, length of hospital stay, number of comorbidities, and number of medical interventions. Conclusion: Palliative care was more easily integrated in those with more comorbidities and medical interventions.

並列關鍵字

COVID-19 ； palliative care ； palliative care integration

參考文獻

Mehta OP, Bhandari P, Raut A, et al. Coronavirus Disease (COVID-19): Comprehensive Review of Clinical Presentation. Front. Public Health 2021 Jan 15; 8: 582932.

Who-China-Joint-Mission-on-Covid-19- Final-Report.pdf. Available online at: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf (accessed June 1, 2020).

Almeida L, Silva TJ , Silva D, et al. Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19. J Pain Symptom Manage 2022; 63: 680-688.

Lovell N, Maddocks M, Etkind SN, et al. Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. J Pain Symptom Manage 2020; 60(1): e77-e81.

Mendis R, Haines A, Williams L, et al. Palliative care and COVID-19 in the Australian context: a review of patients with COVID-19 referred to palliative care. Australian Health Review 2021; 45: 667-674.