兒童醫療中的人性考量：快速順序誘導插管與維生醫療撤除

Humanity in Pediatric Care: Rapid Sequence Intubation and Ventilator Withdrawal

李銘峻(Ming-Chun Li) ； 楊文理(Winnie Yang)

《北市醫學雜誌》 16卷1期 (2019/03) Pp. 34-43

https://doi.org/10.6200/TCMJ.201903_16(1).0004

摘要

孩童身心靈的需求不同於成人，現今的兒科醫師除了醫治其身體的病痛，也要減少孩童們在醫療過程的不安與恐慌。記得二十多年前剛開始小兒消化次專的胃鏡訓練，老師的教導是嬰兒用“抓”的固定；幼兒就用“綁”的；大孩子可以用“講”的來施行胃鏡檢查。近年來隨著以病人為中心的理念，讓醫療品質更人性化。如何使病童在無痛且肌肉放鬆的狀態下順利接受氣管內管的置入，因而運用快速順序插管（Rapid Sequence Intubation，簡稱RSI）的觀念與技術。同時對於過度使用無效的維生器材來延長患童無意識或極痛苦的生命，以藥物減少脫離呼吸器時窒息的不適來順利撤除維生治療。也符合現代醫療所追求的以病人為中心「人性化的醫療」。

關鍵字

快速順序氣管插管 ； 撤除 ； 維生治療

並列摘要

Children have a different body and mind needs from the adults. Nowadays, the pediatricians manage to reduce the anxiety and panic of children in the treatment process when treating their physical illnesses. In the recent years, with the patient-centered concept, medical care has become even more patient-friendly. Here, we introduce the concept of Rapid Sequence Intubation as a procedure that makes sick children feel less pain and more relaxing during the process of endotracheal tube insertion. We also aim reduce the discomfort caused by excessive use of ineffective life support machine prolonging sick children's life unconsciously and painfully. The issue of withdrawing life-sustaining treatments with drugs to relieve discomfort of suffocation in the care of critically ill pediatric patients which meets the concept of patient-centered humanized medical treatment is discussed.

並列關鍵字

rapid sequence intubation ； withdraw ； life-sustaining treatments