台灣地區長期呼吸器依賴患者之安寧緩和醫療現況與執行成效

Prolonged mechanical ventilation-dependent patient’s Hospice-palliative care Situation and Implementation in Taiwan

游偲翌

安寧緩和 ； 呼吸治療 ； 長期呼吸器依賴 ； Hospice-palliative ； Respiratory care ； Prolonged mechanical ventilation dependent.

中山醫學大學醫療產業科技管理學系碩士班學位論文

2017年

碩士

李亞欣

繁體中文

研究目的：世界衛生組織 (WHO) 將安寧緩和醫療視為持續性照顧不可或缺的一環，強調應積極整合不同疾病之照護。2013年歐洲緩和醫學會 (EAPC)簽署布拉格憲章，也將接受安寧緩和醫療的權利視為基本人權。又據世界緩和醫療聯盟 (WPCA)資料顯示，愈來愈多國家提供安寧緩和醫療服務。就生活及死亡品質而言，國內外研究均顯示接受安寧緩和醫療的末期病人，較能獲致身心安頓與善終18.19.20。目的是讓患者有尊嚴、有品質的走最後一段路，不是延長死亡的，更不是用呼吸器支撐到最後一口氣20。 研究方法：收集台灣地區長期呼吸器依賴患者(PMV)，運用2011年至2013年健保資料庫100萬人抽樣檔進行分析，篩選17歲以上、2011-2012年插管使用呼吸器超過 21天，包括: 侵入性呼吸器、 負壓呼吸器，非侵襲性及陽壓呼吸器，排除2010年曾插管使用呼吸器超過 21天樣本進行次級資料分析。最後2011年有79,399人、2012年有63,192人納入本研究對象。除了描述性統計，研究利用卡方與雙變項探討長期呼吸器依賴患者在安寧緩和醫療簽署狀況之相關。 研究結果： 2011年長期呼吸器依賴(PMV)患者(N=79,399)在呼吸照護中心有簽署安寧緩和醫療的樣本數為187(82.7%)，呼吸照護病房的樣本數則為39(17.3%)；在呼吸照護中心沒有簽署安寧緩和醫療的人有93.3%，顯著高於呼吸照護病房的6.7%(P<0.001)；2012年PMV患者(N=63192) 在呼吸照護中心有簽署安寧緩和醫療的比例為91.7%，顯著高於呼吸照護病房的8.3%；在呼吸照護中心沒有簽署安寧緩和醫療的比例為95.8%，顯著高於呼吸照護病房的4.2%(P<0.05)。 結論：長期呼吸器依賴患者在安寧緩和醫療簽署比例有顯著差異。而2012年長期呼吸器依賴患者簽署安寧緩和醫療數量較2011年的減少；顯示針對安寧緩和醫療需進一步宣導。建議相關單位，未來能將安寧緩和醫療推廣得更到位。

Purpose: The World Health Organization (WHO) is seen tranquility and palliative care an indispensable part of continuing care, emphasizing the importance of actively integrating different diseases. The European Association for the Advancement of Medicine (EAPC) signed the Prague Charter in 2013 accept the right to peace of mind as a basic human right. According to the World Healthcare Alliance (WPCA), more and more countries are providing peace and ease of health care. Life and death in terms of quality, domestic and foreign studies have shown that the end of the patient to receive peace and ease of treatment, more accessible to the body and minds and cousin 18.19.20 The purpose is allow patients to have dignity, quality of the last section of the road, not to extend the death, but not with the respirator to support the last breath 20. Method: To collect Prolonged mechanical ventilation-dependent patients in Taiwan, the use of Health and Welfare Ministry of Health and Welfare Information Science Center issued a health care database 100 million people sampling file, screening more than 17 years of age, 2011 - 2012 intubation using ventilator more than 21 days, including: invasive ventilators, Negative Pressure ventilators, Noninvasive ventilators, Excluded In 2010, patients were intubated using ventilators for more than 21 days for secondary data analysis. Results: In 2011, PMV patients (N = 79399) had 187 (82.7%) samples of peace and comfort in the respiratory care center and 39 (17.3%) in the respiratory care ward; The number of medical samples was 74034 (93.3%), and the number of samples in the respiratory care ward was 5365 (6.7%), P = .000 (P <0.05); 2012 PMV patients (N = 63192) were signed at the Respiratory Care Center (11.8%), the number samples of the respiratory care unit was 12 (8.3%), and the number samples of the respiratory care center was 12 (8.3%), and the number samples of the respiratory care center was 60460 (95.8%), The number of samples was 2597 (4.2%) P = .026 (P <0.05). Showing a significant difference in prolonged mechanical ventilation-dependent patients in tranquility and ease of medical signatures. Conclusion: 2012 Prolonged mechanical ventilation-dependent patients signed the number of peaceful and peaceful medical reductions from the year 2011, from 226 (0.28%) down to 133 (0.21%); show the peace and ease need for further medical care. Suggest the relevant units can refer to the future will be more peaceful promotion of care in place.

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