ICU终末期患者签署放弃治疗对医疗处置的影响  

Impact of forgoing therapy on medical treatments for end-stage critical care patients in ICU

作　　者：刘梦婕[1] 顾琼[1] 赵继军[2] 

机构地区：[1]泸州医学院附属医院ICU,四川省646000 [2]中国人民解放军第二军医大学附属长海医院护理部

出　　处：《中国护理管理》2013年第7期23-26,共4页Chinese Nursing Management

基　　金：国家自然科学基金面上项目(70973136)

摘　　要：目的:了解ICU终末期患者签署放弃治疗对医疗处置的影响,为终末期患者照护提出有针对性的建议措施。方法:回顾性研究一所三级甲等医院综合ICU 2011年1-12月的所有住院患者,以自拟病历分析指标表进行资料的收集,调查放弃治疗前、后医疗处置的差异,比较两组死亡患者死亡前48h医疗处置的不同。结果:ICU终末期患者在放弃治疗前均有较高的比例接受急救处置;签署放弃治疗后的患者则有较高比例选择不予治疗及完全撤除治疗,但签署放弃治疗患者在临终前仍然有1/3接受至少一项急救处置。结论:应加强ICU终末期患者放弃治疗的规范化签署程序,指导ICU医护人员正确对待已经进入终末期患者的救治,减少或避免无效或无益的抢救,避免我国有限医疗资源的浪费,减轻家庭和社会的医疗负担,提高ICU终末期患者的死亡质量。Objective： To explore the impact of forgoing therapy on medical treatments for end-stage critical care patients in ICU. Methods： It was a retrospective survey at one general ICU in a tertiary hospital. A self-administered questionnaire was used to collect the data of patients who stayed in ICU from January to December 2011. The patients＇ demographic data, critical care treatments they got in ICU, such as mechanical ventilation, CPR, parenteral nutrition, et al, were included in this questionnaire. Based on whether they signed forgoing therapy documents, the patients were divided into two groups, give-up group and non give-up group. The differences of medical treatments before and after the signature in give-up group were collected and analyzed. For patients who passed away in the two groups, the critical care treatments they received in 48 hours before they died were also compared. Results： A high percentage of patients in give-up group got emergency treatments before forgoing therapy. And after signing forgoing therapy documents, most of them selected withholding or withdrawing medical treatments. But one third of dying patients in give-up group still received at least one of sub-category of active critical care treatments. Conclusion： Standardized forgoing therapy documents signing procedure was needed in managing end stage patients in ICU. It would be useful to help medical staff to deal with end stage patients properly, reduce invalid or useless rescue, avoid the waste of limited medical resources in China, decrease the medical care burden of the family and society, and improve the death quality of end- stage patients in ICU.

关 键 词：ICU 终末期患者 放弃治疗 积极治疗 不予治疗 撤除治疗 

分 类 号：R47[医药卫生—护理学]