某區域醫院不予插管（DNI）病人使用非侵襲性呼吸器（NIV）之現況分析

Experience Analysis of DNI (Do No Intubation) Patients Using NIV (Non-Invasive Ventilator).

10.6537/TJHPC.2017.22(1).2

馬瑞菊(Jui-Chu Ma)；馬瑞萍(Jui-Ping Ma)；鄭佩玲(Pei-Ling Cheng)；張喬茹(Chiao-Ju Chang)；林佩璇(Pei-Xuan Lin)；蕭嘉瑩(Chia-Ying Hsiao)；蘇珉一(Min-I Su)

不施行心肺復甦術 ； 不予插管 ； 非侵襲性呼吸器 ； 症狀緩解 ； 緩和醫療 ； DNR(Do Not Resuscitate) ； DNI (Do not intubation) ； NIV(Non-invasive ventilator) ； Symptom relief ； Palliative care

安寧療護雜誌

22卷1期（2017 / 03 / 01）

13 - 26

繁體中文

研究目的：探討不予插管(DNI)病人使用非侵襲性呼吸器(NIV)之現況分析。材料與方法：採電子病歷回溯性調查設計，以2013年8月1日至2015年7月31日(共2年)住院中不予插管(DNI)病人使用非侵襲性呼吸器(NIV)個案進行分析。結果：DNI病人共216位，平均年齡為77.22歲(SD = 13.13)、NIV平均使用天數為6.76天(SD = 6.99)、平均住院天數為16.9天(SD = 12.42)、加護病房平均住院天數為2.59天(SD = 5.54)、醫療支出平均為2756599.3(SD = 4458370.27)元。Standard treatment使用NIV病人共103位(佔47.69%)，Symptom relief使用NIV病人共113位(佔52.31%)，而DNI病人使用NIV後仍插管的比率以Standard treatment組顯著高於Symptom relief組(6.8% vs. 0.9%；p = 0.022)，死亡率以Symptom relief組顯著高於Standard treatment組(61.1% vs. 42.7%；p = 0.007)，Symptom relief組若有使用NIV之禁忌症如；病人意識不清者有72.5%(N = 50)死亡，血液動力學不穩者則有47.8%(N = 33)死亡。結論：不予插管(DNI)病人中約有五成病人是為了緩和醫療(Symptom relief)的目的而使用NIV，但較Standard treatment使用者死亡率顯著為高，而使用NIV有意識不清之禁忌症者其死亡率更高達七成，因此醫療人員在提供病人或家屬維生醫療抉擇時必須詳盡說明優劣，對於意識不清者更應謹慎使用。

Purpose: This analysis is to explore the experiences of DNI patients using NIV. Materials and methods: The survey of the analysis is designed by tracing back the electric medical record of DNI patients using NIV from August 1st 2013 to July 1st 2015. Results: There are totally 216 patients and their information are as follows: average age of 77.22 (SD = 13.13), 6.76 days (SD = 6.99) of using NIV, 16.9 days (SD = 12.42) of hospitalisation, 2.59 days (SD = 5.54) in ICU, and NT$3,301,752.06 spent (SD = 5277696.38) in medical care. There are 103 patients (47.69%) using NIV in Standard treatment whilst there are totally 113 patients (52.31%) using NIV in Symptom relief. The ratio that DNI patients require intubation after using NIV in group of Standard treatment is significantly higher than that in Symptom relief (6.8% vs. 0.9%; p = 0.022). The death ratio of Symptom relief is significantly higher than that of Standard treatment (61.1% vs. 42.7; p = 0.007). If there was disease not allowed to use NIV (e.g. unconsciousness) in the group Symptom relief, the death ratio would be 72.5%. And patients with unstable hemadynamics are of 47.8% death ratio (N = 33). Conclusion: Around 50% of DNI patients are using NIV for palliative care (Symptom relief), but the death ratio is significantly higher than that of Standard treatment. Patients using NIV as a result of inconvenient disease of unconsciousness are of 70% death ratio. Thus, when medical crew is offering patients or their family medical options, they must explain all pros and cons detail, especially for those in unconsciousness.

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