慢性阻塞性肺病的末期醫療照護

End-of-Life Care in Chronic Obstructive Pulmonary Disease

張惠雯(Hui-Wen Chang)

《安寧療護雜誌》 15卷1期 (2010/03) Pp. 81-93

https://doi.org/10.6537/TJHPC.2010.15(1).6

摘要

世界衛生組織推測，到2020年，慢性阻塞性肺病(COPD)將成爲世界排名死亡率第三名；失能率第五名。從民國98年9月開始，八大類非癌症末期疾病也可納入安寧照護。末期該如何定義？是以生命存活期長短？還是死亡無法避免時？尚無指標能準確的預估死亡率及存活期，COPD的末期跟嚴重度不一定能掛上等號。經常是共存疾病加重原先慢性疾病狀態，使得死亡率提高。COPD的末期同肺癌患者均有疼痛、呼吸困難及衰弱，卻比肺癌患者有明顯日常生活功能變差，影響社會功能、焦慮、憂鬱，但COPD患者接受安寧療護卻比肺癌患者少。影響末期COPD生活品質的障礙有：無法預料末期COPD的預後；瀕臨呼吸衰竭時，跟家屬討論時間有限；疾病認知錯誤，認爲放棄使用維生措施，等同放棄救治病人。醫療預立指示(Advanced Directive)，除了維護患者生命末期的醫療自主權，也讓家屬在危急時能有決策依據可尋，減少心理負擔，也讓病患善終。尚須更多研究去分析醫療預立指示對COPD患者及家屬的影響。

關鍵字

生命末期 ； 慢性阻塞性肺病

並列摘要

World Health Organization predicted that Chronic obstructive pulmonary disease (COPD) will become the third leading cause of mortality and the fifth cause of disability in 2020 worldwide. Starting from September 2009, there are eight group of disease at terminal stage tally with hospice care in Taiwan. How de we define the terminal stage of COPD? Could be the definition of terminal COPD by limited life span or incurable status? Limited data exist describing risk factors for mortality in patients having COPD, terminal stage might not matched the severity of disease. But there was very often dying in COPD attributed to co-morbidities. COPD patients have the same problem with lung cancer patients, such as pain, breathlessness, fatigue, depression and anxiety, impaired daily function and social activity, but the COPD patients had poor hospice care than the cancer group. There are barriers to end-of life care in COPD; unpredictable prognosis, little time for discussion of do not resuscitate order, misunderstanding. We need further study on the advanced directive in COPD patients and family.

並列關鍵字

end-of-life ； chronic obstructive pulmonary disease