癌末病人使用皮下輸注現況之探討

The Use of the Hypodermoclysis for Terminal CancerPatients

林純如 ； 胡文郁 ； 王浴 ； 呂佩佩

《安寧療護雜誌》 16卷1期 (2011/03) Pp. 14-26

https://doi.org/10.6537/TJHPC.2011.16(1).2

摘要

皮下輸液注射是一種經腸道外攝取營養水分的方式，可提供吞嚥困難或進食不足之癌症病人獲得適當的熱量，讓出院準備得以順利進行。本研究旨在探討國內癌末成年病人使用皮下輸注(hypodermoclysis；HDC)的現況。本研究設計採半結構式問卷，向45所安寧機構護理長電訪；另以某醫學中心為例，採病例回顧方式，分析2006~2010 年13 位接受安寧居家療護使用皮下輸注之資料。研究結果顯示：1.國內曾經有53.3% (24/45)安寧醫療機構使用HDC。然而，其中有四分之一因使用經驗不佳故目前已停止使用此輸液方式。2.南區某一醫療機構的居家療護皮下輸注使用率高，並表示效果佳與病人評價良好。3.某醫學中心安寧居家療護病人於照顧期間，有12.7%(13/102)因吞嚥困難或不放置餵食管路而使用HDC，以輸液量中位數500ml/天的等張溶液輸注，病人期望最終往生地點之達成率為100% ，期間無病人因營養水分不足而再入院。4.病人皆未因使用HDC 而產生疼痛，有3 位病人有注射部位局部膿瘍及輕微浮腫之副作用，經更換注射部位與調慢輸液速度後，不良症狀均已改善。藉本文能提供讀者對HDC 有更進一步的認識，且適切地應用於病人照護實務。

關鍵字

皮下輸注 ； 皮下輸液 ； 吞嚥困難 ； 末期照護

並列摘要

Background: Subcutaneous injection was an alternative route to enteral feeding. It was another solution for dysphagia and poor oral intake and provided sufficient nutrition for terminal cancer patients. The aim of this study was to demonstrate the clinical application of hypodermoclysis (HDC) in terminal cancer patients. Method: The research designed a hemi-structure questionnaire to collect data by phone interview the leader nurses in domestic hospice ward. We performed retrospective chart review and selected 13 cases who receiving HDC during 2006 to 2010 in a medical center hospital. Result: (1) The proportion of the experience of subcutaneous fluid infusion in all domestic hospice wards was 53.3% (24/45). Around one-fourth of the hospice ward abandoned the technique.(2) The hospice home cases at the northern medical center in Taiwan showed a high percentage of HDC application with good clinical effect and patient response.(3) 12.7% (13/102) hospice home cases used subcutaneous infusion for dysphagia at the northern medical center in Taiwan from 2006 to 2010. The infusion fluid was isotonic and the median volume of infusion was 500 ml/day. All thirteen cases met the propriety of their death place and did not readmitted for insufficient nutrition or hydration.(4) No patient reported local pain after subcutaneous injection, only three patients complained about local inflammation and swelling which subsided after changing injection position and titrating down injection rate. Conclusion: Subcutaneous infusion certainly had a role of clinical practice. Our research provided better comprehension and application of the technique.

並列關鍵字

hypodermoclysis ； subcutaneous infusion ； dysphagia ； terminal care