內科加護病房高齡病人臨終維生醫療處置之現況

Current use of Life Sustaining Treatments for Elderly Dying Patients in Intensive Care Units

10.6537/TJHPC.201912_23(3).01

馬瑞菊(Jui-Chu Ma)；李孟君(Meng-Chun Li)；吳珮菁(Pei-Ching Wu)；邱怡蓉(Yi-Jung Chiu)；鄭婉如(Wan-Ju Cheng)；李佳欣(Chia-Hsin Li)；蕭嘉瑩(Chia-Ying Hsiao)；蘇珉一(Min-I Su)

加護病房 ； 高齡末期病人 ； 維生醫療 ； 不施行心肺復甦術討論 ； 緩和醫療 ； Intensive care unit ； Terminally ill elderly patient ； Life sustaining treatments ； DNR discussion ； Palliative care ICU

安寧療護雜誌

23卷3期（2019 / 12 / 01）

205 - 220

繁體中文

研究目的：探討內科加護病房高齡病人臨終前接受維生醫療之現況。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07月31日入住內科加護病房之臨終病人380人為研究對象。結果：臨終之高齡（≧65歲）病人有227人（占59.7%），其中符合Salpeter（2012）末期定義（存活期≦6M）者共163人（占71.8%），預立安寧緩和意願書比率為1.3%。高齡病人入住加護病房至臨終前接受維生醫療之平均值為100次（SD＝185），而高齡與否及是否符合末期定義在臨終前接受之維生醫療並無差異，惟早期介入DNR討論之高齡病人在臨終前接受維生醫療之總數較未討論DNR者明顯減少（22.2 ± 29vs. 155±225 p＜0.001），尤以CPR次數、手術次數、抽血檢查、抽痰、周邊及中心靜脈導管、內視鏡、洗腎等次數及點滴輸液、導尿管、鼻胃管、氣管內插管天數、呼吸器使用天數等具有顯著差異。結論：高齡與否及是否符合末期定義在臨終前接受之維生醫療並無差異，然早期介入DNR討論可以顯著下降內科加護病房高齡病人維生醫療之使用，因此建議除宣導高齡民眾預立醫療決定外，對於入住加護病房高齡末期病人儘早介入DNR討論並提供緩和醫療之選項，俾能減少維生醫療之苦。

Objectives: To explore the current life sustaining treatments (LST) received by elderly dying patients of intensive care units (ICU). Materials and Methodology: Retrospective study on electronic medical record. Study subjects are targeted at 380 dying patients living in intensive care units from 1^(st) August 2013 to 31^(st) July 2015. Result: There are 227 elderly dying patients (59.7%) aged over 65, 163 of which (71.8%) match the definition of a terminal stage (＜= 6 month survival), and the rate of completing an advance directive of hospice palliative care referral form is 1.3%. The average number of elderly patients staying in ICUs and receiving LSTs before dying is 100 (SD = 185). Furthermore, aging and matching definition of a terminal stage do not make difference in the type of LSTs they received before dying. The only difference is that the early introduction of DNR discussion results in lower number of elderly patients who received LSTs before dying than those who have not discussed DNR (22.2±29 vs. 155±225 p＜0.001). In particular, remarkable differences are shown in the number of CPR, surgeries, blood test, sputum suction, peripheral and central venous catheter, endoscopy, kidney dialysis, days of receiving parenteral hydration, foley, nasogastric tube and endotracheal tube, and days of using ventilators. Conclusion: We conclude aging and matching the definition of a terminal stage make no difference in the LSTs received before dying. However, early introduction of DNR discussion can notably reduce the use of LSTs provided to elderly patients in ICUs. Accordingly, it is suggested that in addition to the promotion of advance directives to elderly people, for terminal elderly patients staying in ICUs, early introduction of DNR discussion and the provision of palliative care can lessen their suffering when receiving LSTs.

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