The Outcome of Terminal Cancer Patients Requiring Prolonged Mechanical Ventilation

癌症末期病患需要長期呼吸器之預後

10.29806/TM.200608.0001

黃俊耀(Chun-Yao Huang)；吳燿光(Yao-Kuang Wu)；黃崇旂(Chung-Chi Huang)；蔡熒煌(Ying-Huang Tsai)

末期癌症病患 ； 呼吸衰竭 ； 長期依賴呼吸器 ； terminal cancer patients ； respiratory failure ； prolonged mechanical ventilation

胸腔醫學

21卷4期（2006 / 08 / 01）

305 - 312

英文

背景：有將近76%比率的癌症病患在加護病房因呼吸衰竭死亡。而其呼吸衰竭的原因並非肺炎或是肺栓塞。目前並無論文刊載有關成人癌症病患因呼吸衰竭需要長期使用（超過二十一天）呼吸器之預後。本研究之目的主要在探討及描述末期癌症病患因呼吸衰竭需要長期使用呼吸器之預後。 方法：回溯性的數據收集，從西元1999年11月到2004年8月將近五年，針對1124位住進成人呼吸照護中心的病患加以分析。所有末期癌症之病患，因呼吸衰竭需要長期呼吸器使用者全部進入本研究。連續性的統計數據及變數收集：包括年齡、性別、住進成人呼吸照護中心當時的疾病嚴重度(APACHE score)、生化指數、病患意識昏迷指數(Glascow coma scale)、加護病房留置天數、腫瘤種類、及動脈血氣體分析數據等。轉出成人呼吸照護中心及出院後之生命指數狀況以醫院之病歷記錄和直接電話訪問病患家屬追蹤獲得。 結果：總計92位末期成人癌症之病患符合本研究之條件。有23位病患後來轉出成人呼吸照護中心。其中有15位病患成功脫離呼吸器，有8位病患長期依賴呼吸器。在成功脫離呼吸器這一組之病患，有8位病患在3個月內在院內死亡，其他7位病患順利出院。但是全部都在出院後4個月內死亡。在長期依賴呼吸器這一組之8位病患，有1位病患在院內死亡，其他7位病患順利出院轉至地區呼吸照護病房。在下轉地區呼吸照護病房之7位病患，其中5位病患在2個月內死亡，只有2位病患存活超過2個月。所有92位末期成人癌症病患平均住院死亡率為84%，轉出呼吸照護中心之平均存活天數為70天。在成功脫離呼吸器這一組之病患，其疾病嚴重度(APACHE Ⅱ score, p=0.001)和血清尿素氮(BUN, p=0.0049)值明顯低於長期依賴呼吸器這一組。病患意識昏迷指數(Glascow coma scale, p=0.004)值明顯高於長期依賴呼吸器這一組。在本研究之分析：年齡、性別、生化指數、加護病房留置天數、腫瘤種類、及動脈血氣體分析數據等並非明顯影響預後之變數因子。 結論：所有末期癌症病患需要長期呼吸器使用者之平均住院死亡率高達84%，轉出呼吸照護中心之平均存活天數只有70天。病患有較低疾病嚴重度、血清尿素氮，和較高意識昏迷指數者，明顯有較高之呼吸器脫離率。本研究之結果，可以提供臨床醫師和病患家屬討論，當末期癌症病患呼吸衰竭時，積極插管治療或者安寧照護是比較合適的。

Background: Approximately 76% of patients with malignancies die because of respiratory failure, excluding pneumonia and pulmonary embolisms, in intensive care centers (ICU). Currently, no published paper has described the outcome of adult cancer patients who require prolonged mechanical ventilation (PMV) (more than 21 days) for respiratory failure. The objective of this study was to describe the outcome of terminal cancer patients requiring PMV. Methods: A retrospective study of 1124 patients who were admitted to our respiratory care center (RCC) from November 1999 to August 2004 was carried out. All terminal cancer patients with respiratory failure requiring prolonged mechanical ventilation were included in the study group. Demographic and clinical variables, such as age, gender, APACHE score at RCC admission, biochemistries, Glascow coma scale, ICU admission day, cancer types, and blood gas result, were obtained from consecutive respiratory failure patients. Information regarding vital status after hospital discharge was also acquired. Results: Our analysis was based on data from 92 adult terminal cancer patients who met the criteria. Twenty-three patients were transferred out of the RCC, including 15 successfully weaned patients and 8 ventilator-dependent patients. In the successfully weaned group, 8 patients expired within 3 months, and the other 7 were discharged from the hospital, but all of them died within 4 months. In the ventilator-dependent group, 1 patient died in the hospital, and 7 were transferred to a local respiratory care ward (RCW). After being admitted to the RCW, 5 of 7 patients expired within 2 months, and only 2 survived more than 2 months. The overall observed in-hospital mortality was 84%, and mean survival time after discharge from the RCC was 70 days. The APACHE Ⅱ score (p=0.001) and serum BUN (p=0.0049) were significantly lower in the successfully weaned group, and the Glascow coma scale was higher in this group (p=0.004). In our analysis, age, gender, cancer type, and ICU admission days were not significant factors influencing the outcome. Conclusion: The overall in-hospital mortality of terminal cancer patients requiring PMV was as high as 84%, and mean survival times after discharge from the RCC were only 70 days. The patients with a lower BUN level and severity of disease had a higher ventilator weaning rate. This result may be of help to physicians and families when discussing whether aggressive or hospice care is more suitable for terminal cancer patients with respiratory failure.

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