東部區域醫院加護病房不施行心肺復甦術醫囑之流行病學調查

The Investigation on Epidemiology of DNR Order in the Intensive Care Units of the Teaching Hospital in the Eastern Region

馬瑞菊(Jui-Chu Ma) ； 李佳欣(Chin-Hsin Li) ； 林佩璇(Pei-Xuan Lin) ； 陳昱臻(Yu-Zhen Chen) ； 于豎惠(Shu-Hui Yu) ； 鄭婉如(Wan-Ju Cheng) ； 蕭嘉瑩(Chia-Ying Hsiao) ； 蘇珉一(Min-I Su) ； 邱怡蓉(Yi-Jung Chiu)

《內科學誌》 31卷4期 (2020/08) Pp. 284-292

https://doi.org/10.6314/JIMT.202008_31(4).09

摘要

台灣自1980年代起開始發展安寧療護，在2000年通過安寧緩和條例。本研究主要調查在東部區域醫院內科加護病房不施行心肺復甦術醫囑之流行病學。於東部區域教學醫院，採電子病歷回溯性調查設計，以2013年8月1日至2018年04月30日入住內科加護病房之病人2994人為研究對象。加護病房入住之癌症病人佔3.4%（101/2994），非癌症病人佔96.6%。有DNR order之個案共1062位（佔35.5%），其中癌症病人之DNR order較非癌病人顯著為高（50.5% VS. 34.9% P＜0.001）。住院中死亡人數佔25.5%（763/2994），死亡之前有DNR order之比率為90.8%（693/763），死亡之病人加護病房期間有裝置中心靜脈導管以非癌症病人顯著高於癌症病人（62.3% VS. 45.2% p=0.028）、死亡前有使用緩和鎮靜藥物以癌症病人顯著高於非癌症病人（40.5%VS.19.7%p=0.001）。死亡之病人平均住院日為7.4天而開立DNR order距離死亡之平均時間為5.8天（SD=11.2）。入住加護病房以非癌病人居大宗，DNR order佔三成，癌症病人之DNR order較非癌病人高。因此除須重視加護病房非癌病人緩和醫療需求外，醫療人員須及早告知病情並讓病人參與自己治療方向的討論。病主法實施之後尤需宣導民眾在意識清醒前充分表達意願。

關鍵字

加護病房（Intensive care unit） ； 不施行心肺復甦術醫囑（Do not resuscitation order） ； 緩和醫療（Palliative care）

並列摘要

Hospice care in Taiwan has been developed since the 1980s and the Hospice Palliative Care Act was passed in 2000. This study intends to investigate the epidemiology of DNR order in the intensive care units of the teaching hospital in the eastern region. A retrospective investigation is designed with electronic medical records to make an analysis on 2994 patients in the intensive care units of the teaching hospital in the eastern region from August 1, 2013 to April 30, 2018. In the intensive care units, cancer patients account for 3.4% (101/2994) and non-cancer patients account for 96.6%. There are 1062 patients with DNR order (35.5%). Among them, the number of DNR order of cancer patients is more than that of non-cancer patients (50.5% VS. 34.9% P= 0.001). The number of deaths in the hospital account for 25.48% (763/2994) and the rate of having DNR order before death is 90.8% (693/763). The rate of non-cancer patients using central venous catheter before death is higher than cancer patients using it before death in the intensive care units (62.3% VS. 45.2% p =0.028) and the rate of cancer patients using palliative sedation before death is higher than non-cancer patients using it before death (40.5% VS. 19.7% p =0.001). The average length of stay in the hospital for patients before death is 7.4 days; however, the average interval for patients with DNR order before death is 5.8days (SD =11.2). Non-cancer patients admitted to the intensive care units are in the majority and patients with DNR order account for 30%. The number of DNR order of cancer patients is more than that of non-cancer patients. In addition to considering the requirement of palliative treatment for non-cancer patients in the intensive care units, health care workers should inform the illness early to patients and let them be involved to discuss the treatment which they prefer. After the implementation of the Patient Right to Autonomy Act, it is particularly required to instruct people to fully express their wishes when they are conscious.