臨終受苦指數與不施行心肺復甦術(DNR)

Suffering Scores in the End-of-Life and Do No Resuscitation (DNR)

10.6537/TJHPC.2015.20(2).1

陳安芝(An-Chih Chen)；賴德仁(Te-Jen Lai)；周希諴(Hsi Hsien Chou)

臨終 ； 受苦指數 ； 安寧緩和醫療 ； 不施行心肺復甦術 ； 侵入性處置 ； end-of-life ； suffering scores ； hospice care ； DNR (do not resuscitate) ； invasive management

安寧療護雜誌

20卷2期（2015 / 07 / 01）

105 - 119

繁體中文

研究目的：在生命的末期，常有一些侵入性的維生醫療，雖然暫時延長生命，但同時帶來生理及心理的受苦。本研究將臨終的侵入性治療，量化為「受苦指數」，同時比較簽署「不施行心肺復甦術(Do no resuscitation，DNR)」與否，實際上所接受的侵入性治療，是否有顯著差異。材料與方法：回溯中台灣某醫學中心，2010年1月到2012年12月之間，臨終病人的病歷資料，包含總住院天數、加護病房住院天數、侵入性治療(受苦指數：包括侵入性管路數目、手術次數)、氣管內管使用天數等資料，比較DNR與否之間的差異。結果：有簽署DNR的臨終病人，臨終前平均總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)、受苦指數明顯較低(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)。結論：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；將侵入性治療量化為受苦指數，可作為臨床工作者客觀的數據資料，協助病人及家屬作出減少臨終受苦的醫療決定。

Purpose: In the end-of-life, some invasive futile medical care only prolonged life transiently, but also prolonged the suffering in physical and psychological status. This study tried to identify the invasive managements in the end-of-life as ＂suffering scores＂, to compare the difference of invasive management between patients with ＂do no resuscitation＂ (DNR) or not. Method: This study analyzed the clinical medical records of patients passed away in one medical center in middle Taiwan, including days of hospitalization, days of intensive care unit (ICU) stay, invasive management (Suffering scores: sum of numbers of invasive tubes and times of operations), and days of mechanical ventilation dependence; to analyze the difference between with/without do-not-resuscitate (DNR) order. Results: The average day of hospitalization had no significant difference in patients with DNR order or not (with DNR: without DNR=16.8: 13.1 days, p=.114). The average of ICU stay was much less in the DNR group (with DNR: without DNR=6.3:10.5 days, p＜.001). The average of Suffering scores was significant decreasing (with DNR: without DNR=3.23:5.23, p＜.001), and the average stay with mechanical ventilation dependence was lower in the DNR group (with DNR: without DNR=5.05:8.00, p＜.001). Conclusion: DNR could lower the futile medical care in the end of life effectively and decreased the patients’ suffering. Identifying the invasive managements to ＂Suffering scores＂, could offer an objective data for clinical staffs, to help patients and their families in decision making about lower the suffering in the end of life.

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