高齡晚期腎臟病患者選擇安寧緩和照護之分析

目的：越來越多研究顯示保守性治療或是接受緩和照護相較於透析治療能有相同或更好的生活品質而死亡率卻相當。所以希望藉由本篇研究了解腎病晚期之高齡病人後續願意接受安寧療護之相關因素。方法：本回溯性研究針對自2010/10至2019/10於南部某醫學中心腎臟科門診中，65歲以上腎臟疾病第四或第五期需考慮透析之病人，經轉介衛教後讓病人或家屬決定是否接受透析或是安寧緩和照護。蒐集病人基本資料、共病指標、相關共病、檢驗數據，不施行心肺復甦術簽署狀況、住院情形、存活情形等資料，以SPSS軟體進行卡方檢定、t-test、二元邏輯迴歸模式等檢定分析。結果：本研究總共納入78位病人。其中28位接受安寧緩和照護，50位安寧未收案，在基本資料分析中，兩組年齡、性別、共病指標、檢驗數據等均沒有顯著差異。病人有癌症（p=0.03）或過去30天住院曾住院者（p＜0.01）均有較高機率接受安寧緩和照護。經邏輯迴歸分析校正後，過去30天曾住院者有較高機率接受安寧緩和照護。而接受安寧緩和照護者，在30天平均可減少住院次數約0.25次。結論：若腎臟病晚期之高齡長者近期曾住院，有較高比率會選擇接受安寧緩和照護。接受緩和照護患者住院次數較未接受者少。

關鍵字

高齡；晚期腎臟病；緩和照護

並列摘要

Objectives: An increasing number of studies have shown that, compared to dialysis, conservative or palliative care for elderly patients with advanced kidney disease reports a similar mortality rate but offers a better quality of life. The study accordingly aimed to explor the factors prompting elderly patients with advanced kidney disease to choose palliative care. Methods: The retrospective study exmained patients over 65 years old who were asked to consider dialysis after visiting the nephrology outpatient department of a medical center in southern Taiwan during the period from October 2010 to October 2019. The patients and their families were provided detailed information about dialysis and palliative care to assist them in decision making. Patients' baseline characteristics (demographics, comorbidities, laboratory parameters, do-not-resuscitate signature status) and outcomes (hospitalization, emergency room visit, etc.) and related data were collected and analyzed with SPSS software for chi-square test, t-test, and binary logistic regression analysis. Results: Of the 78 patients examined, 28 chose and 50 declined palliative care. There were no significant difference in age, gender, Charlson comorbidity index, and lab data between the two groups of patients. In both groups, patients with cancer (p=0.03) and those hospitalized in the past 30 days (p＜0.01) were more likely to choose palliative care. After adjustment by logistic regression analysis, those hospitalized in the past 30 days were more likely to choose palliative care. The palliative care group reduced hospitalization by 0.25 times in one month. Conclusion: Recent experience of hospitalization appears to make it more likely for elderly patients with advanced kidney disease to choose palliative care over hemodialysis, and palliative care is associated with a lower unumber of short-term hospitalization among these patients.

並列關鍵字

elderly ； advanced kidney disease ； palliative care

被引用紀錄

洪姵如（2023）。末期腎臟病患者的最後一哩路〜安寧照護。彰化護理，30(4)，9-13。https://doi.org/10.6647/CN.202312_30(4).0003

楊舒雅（2023）。末期腎臟病及透析患者之安寧照護。彰化護理，30(4)，2-8。https://doi.org/10.6647/CN.202312_30(4).0002

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