末期心衰竭的安寧緩和治療

Palliative Care in Advanced Heart Failure

10.29462/TGG.200705.0006

賴秀昀(Hsiu-Yun Lai)；陳亮恭(Liang-Kung Chen)；黃信彰(Shinn-Jang Hwang)

心衰竭 ； 安寧緩和醫療 ； heart failure ； palliative care

台灣老年醫學雜誌

2卷4期（2007 / 05 / 01）

277 - 282

繁體中文

隨著人口老化，心衰竭逐漸成爲威脅國人健康的重要疾病狀況。五分之一的心衰竭病患，會在診斷後的一年內死亡。心衰竭與大多數的癌症一樣，會產生許多不適的症狀徵候，然而安寧緩和醫療運用在心衰竭上，比癌症照顧遭遇更多的挑戰。由於心衰竭病程的不確定性，臨床醫師常常未能及早與病患討論臨終議題，大部分的病患在過世前也未接受安寧緩和醫療的照顧，病患對於自己的病況及預後也比較不瞭解。由於心衰竭的預後不易預測，安寧緩和醫療的介入時機，應以「需求」而非「預後」作爲考量，傳統治療之外，醫師須主動與病患及家屬討安寧緩和治療的選擇。在末期心衰竭的處理上，治療心衰竭的藥物，同時亦能減輕病患的不適症狀。隨著病程進展，單靠這些藥物往往無法完全消弭症狀徵候，此時就需緩和性的治療來增加病患的舒適度。至於心臟節律器、植入性心臟去顫器及心室輔助裝置的使用與否，應以病患整體的照護目標爲考量，並於植入後持續追蹤。整體言之，對於末期心衰竭病患的照護，醫師除了給予病患有效的治療之外，應同時緩解不適症狀，以及整合治療目標，以提供病患最高品質的照護。

Along with population aging, the increasing prevalence of heart failure has become a major health challenge in developed countries. One fifth of the patients with heart failure may die within 1 year after diagnosis. Like cancer, heart failure carries a high symptom/sign burden, but very few patients receive palliative care before their deaths. Based on the unpredictable prognosis of heart failure, applying palliative care to heart failure patients should be symptom focused, instead of prognosis. In addition to conventional treatment for heart failure, discussions of palliative care with patients and their families must be initiated by physicians. Medications that improve survival of heart failure also ameliorate the symptom load. Nevertheless, palliative care is frequently needed when disease deteriorates. Although being capable of reducing the mortality of heart failure, the increasing use of pacing devices poses significant problems on end-stage heart failure management. The choice of using these devices should take a careful consideration of the overall treatment goal. In summary, physicians should provide better quality of care for patients with advanced heart failure by integrating optimal medical management with palliative care.