末期病人撤除維生醫療－某醫學中心之經驗

杜明勳; 黃資雅; 陳如意; 曾馨慧; 鍾瑞美; 林璊鸚

doi:10.6537/TJHPC.2016.21(3).4

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P289 - 303

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6537/TJHPC

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末期病人撤除维生医疗－某医学中心之经验

Withdrawal of Life-sustaining Treatment in Terminal Ill Patients: A 2-year Experience in a Medical Center

杜明勳(Ming-Shium Tu) ；黄资雅(Tzu-Ya Huang) ；陈如意(Ru-Yi Chen) ；曾馨慧(Shin-Hui Tzeng) ；锺瑞美(Jui-Mei Chung) ；林璊鹦(Many-Zng Lin)

安宁疗护杂志； 21 卷 3 期 (2016 / 11 / 01) ， P289 - 303

繁体中文 DOI： 10.6537/TJHPC.2016.21(3).4

撤除维生医療；无效医療；拔管；安寧缓和医療；末期病人； withdrawal of life-sustaining treatment ； futile medical care ； extubation ； palliative care ； terminal ill patient

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摘要 │ 参考文献 (14) │ 被引用文献 (3) │ 国际计量

摘要〈TOP〉

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Purpose: To evaluate the characteristics of withdrawal of life-sustaining treatment in terminally ill patients in a medical center in southern Taiwan. Methods: We conducted a retrospective survey of terminal ill patients received hospice-shared care for withdrawal of life-sustaining treatment in a medical center from January 1, 2014 to December 31, 2015. The demographic characteristics, the background of medical staffing and family members, and the process of family conference and withdrawal of life-sustaining treatment were collected for analysis. Results: Overall, 82 patients (mean age 68.9 ± 19.1 years, 53 males (64.6%) and 29 females (35.4%)) were enrolled in this study. Regarding the main diagnosis, the first on the rank were malignancy (24.4%) and lung disease (24.4%). 50 males (61.7%) and 31 females (38.3%) (mean age 50.3 ± 12.4 years) were mainly interviewed by hospice-shared care nurse, including 23 spouses (28%), 41 grown children or grandchildren (50%), and 13 parents (15.9%). 68 patients (84.0%) had tight family cohesion. The consent for withdrawal of life-sustaining treatment was signed by the family members in 81 patients. One unconsciousness patient had no family. Family conference was held with the medical team, hospice shared care team, and the family. Associated problems from the medical team were found in 24 cases. 20 staffs asked to withdraw life-sustaining treatment in 6 hours. 77 families raised questions and most of them (47 families) were concerned about the time to death after withdrawal of life-sustaining treatment. 74 patients had ventilator withdrawn. The mean of time to death after withdrawal of life-sustaining treatment was 3.3 ± 7.5 days. The family cohesion was not associated with the questions that family raised in the family conference. The time to death was significantly longer in patients who transferred to other ward after withdrawal of life-sustaining treatment. Conclusion: More and more terminal ill patients received palliative care and withdrew life-sustaining treatment in recent years. Further study is needed to evaluate the factors that may have influences on withdrawal of life-sustaining treatment.

参考文献 ( 14 ) 〈TOP〉

陈怡钧,高秀娥,黄贵薰(2015)。协助撤除脑瘤末期个案维生医療之护理经验。安寧療护杂志，20，54-66。
连结：
陈惠芳,王筱佩(2015)。照顾一位脊髓小脑退化性动作协调障碍个案撤除维生医療之护理经验。安寧療护杂志，20，186-97。
连结：
财团法人器官捐赠移植登錄中心。2016 年 10 月 3 日，取自https://www.torsc.org.tw/index.jsp。
Cooke, CR.,Hotchkin, DL.,Engelberg, RA.(2010).Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU.Chest,138,289-297.
Hoel, H.,Skjaker, SA.,Haagensen, R.(2014).Decisions to withhold or withdraw life-sustaining treatment in a Norwegian intensive care unit.Acta Anaesthesiol Scand,58,329-336.

被引用文献 ( 3 ) 〈TOP〉

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