末期病人臨終侵入性處置與DNR

在臨床工作中，常會面對到臨終的場景。台灣自民國8 9年立法通過安寧緩和條例，迄今大眾對於安寧緩和醫療雖有初步概念，但對於臨終的醫療處置，仍有一些迷思；臨床醫療人員，仍然會面臨末期病人急救無效卻不得不做的困境。本研究分析中部某醫學中心2010至2012年院內死亡案例，分析臨終病人簽署「不施行心肺復甦術」(do not resuscitate, DNR)的比例，以及侵入性處置的情形。結果得到簽署DNR的族群，臨終前平均住院天數無顯著差異(簽署:未簽署= 16.8 : 13.1, p=.114)、加護病房平均住院天數顯著下降(簽署:未簽署=6.3 : 10.5, p<.001)、侵入性處置分數明顯較低(簽署:未簽署=3.23:5.23, p<.001)、平均插管天數(氣管內管留置)亦明顯減少(簽署:未簽署=5.05:8, p<.001)。數據顯示簽署DNR可有效減低臨終的無效醫療，減低病人不必要的受苦。

關鍵字

臨終；安療緩和醫療； DNR(do not resuscitate，不施行心肺復甦術) ；住院天數；加護病房天數；插管天數；侵入性處置；無效醫療

並列摘要

In clinical practices, the staff members of medical care would deal with the situation of end-of-life. The law of hospice was passed in Taiwan in 2000. The public had been learning about hospice care gradually. However, still some misunderstanding about the invasive managements in end-of-life was found. The staff members of medical care would still perform some life sustaining procedures in patients with end stage disease in the end of life. This study analyzed the patients passed away in a medical center in middle Taiwan, including hospitalization and end-of-life invasive management with/without do-not-resuscitate (DNR) order. Results showed the average day of hospitalization had no significant difference in patients with DNR order (with DNR: without DNR=16.8: 13.1 days, p=.114). The average of intensive care unit (ICU) stay was much less in the DNR group (with DNR: without DNR=6.3:10.5 days, p<.001). The average invasive management score was significant decreasing (with DNR: without DNR=3.23:5.23, p<.001), and the average stay with endotracheal tube insertion was lower in the DNR group (with DNR: without DNR=5.05:8.00, p<.001). The data showed DNR order could effectively decrease futile medical care in end-of-life and the patients’ suffering.

並列關鍵字

end-of-life ； hospice care ； DNR (do not resuscitate) ； hospitalization(days) ； ICU stay (days of intensive care unit stay) ； days with endotracheal tube ； invasive management ； futile medical care

參考文獻

．立法院(2011，1月26日) 。安寧緩和醫療條例。http://glin.ly.gov.tw

．龔蘭芳、郭弘典、陳鴻鈞(2014)。如何推廣末期腎病未透析安寧照護:以南部某醫學中心為例。腎臟與透析 Vol.26 No.l

．林益卿、盧建中、林盈利、徐慧娟、楊佩玉(2011)。台日安寧療護發展之比較。Taiwan Journal of Hospice Palliative Care Vol.16 No.2

．周家汶、陳夏蓮、許正園(2011) 。慢性阻塞性肺疾病病人之安寧療護 Taiwan Journal of Hospice Palliative Care Vol.16 No.1

．吳森期、孫嘉玲、陳詩婷等(2011)。安寧病房中病人、主要照顧者及醫療相關人員緩和療護品質之比較。Taiwan Journal of Hospice Palliative Care Vol.16 No.1

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末期病人臨終侵入性處置與DNR

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