緩慢進展的老年肝癌末期病人繼發腎臟衰竭之安寧療護經驗：個案報告

Palliative Care in the Elderly with Indolent Course of Advanced Hepatocellular Carcinoma Complicated with Renal Failure: A Case Report

10.6537/TJHPC.2014.19(3).8

張悅詩(Yueh-Shih Chang)；王正旭(Cheng-Hsu Wang)；張沛泓(Pei-Hung Chang)；黃彥閔(Yen-Min Huang)；黃仁聖(Jen-Seng Huang)；賴建宏(Chien-Hong Lai)

撤除血液透析 ； 老年醫學 ； 肝癌 ； 腎衰竭末期 ； 安寧療護 ； withdraw hemodialysis ； the elderly ； liver cancer ； end stage renal disease ； hospice care

安寧療護雜誌

19卷3期（2014 / 11 / 01）

323 - 336

繁體中文

本文介紹一位86歲肝癌末期病人，因腎衰竭需規律透析，但症狀並未如預期改善，甚至因透析使得症狀加劇，如腹痛及譫妄。在安寧團隊協助下，除了根據腎臟版利物浦照顧途徑給予藥物調整，也加上漸進式撤除血液透析，讓末期病人的生活品質改善，也緩解家屬長期照護之疲憊。期間有關藥物之選擇及使用方式，與緩和性透析將分別介紹與討論。

We presented an 86 years old female patient in terminal cancer stage who received hemodialysis due to chronic renal failure. In her last life, patient's symptoms, such as delirium and abdominal pain, could not get improving but even worsen after hemodialysis. Under the assistance from hospice care term, patient's quality of late life was improving through medicine and palliative hemodialysis. The adjustment about medicine was done according to o the guideline of Liverpoor Care Pathway for dying patient from renal steering group. Meanwhile, the frequency of hemodialysis decreased gradually. Finally, patient's quality of life improved. Families' anxiety and tiredness were relieved. The issues about drug choice and palliative hemodialysis are discussed thoroughly in the article.