加拿大三级医疗中心新生儿的临终关怀（英文）  

Neonatal end of life care in a tertiary care centre in Canada:a brief report

作　　者：Koravangattu Sankaran Erin Hedin Heather Hodgson-Viden 姚跃 

机构地区：[1]Division of Neonatology,Department of Pediatrics,College of Medicine,University of Saskatchewan

出　　处：《中国当代儿科杂志》2016年第5期379-385,共7页Chinese Journal of Contemporary Pediatrics

摘　　要：当今新生儿的存活率在不断提高,危重症的诊断准确性也较以往有明显改善。但当新生儿基本或完全治疗无望时,其诊疗重心应由积极监护治疗转为临终关怀舒缓治疗。医疗团队需尽早与家长进行多方面沟通,以便对临终关怀达成共识。在某些情况下,一味地延长生命反而会增加患儿的痛苦,并导致家长怀有不切实际的期望。Objective To describe the processes followed by a neonatal team engaging parents with respect to end of life care of babies in whom long term survival was negligible or impossible;and to describe feedback from these parents after death of their child.Methods A retrospective review was conducted of health records of neonates who had died receiving palliative care over a period of 5 years at a tertiary neonatal centre.Specific inclusion criteria were determined in advance that identified care given by a dedicated group of caregivers.Results Thirty infants met eligibility criteria.After excluding one outlier an average of 4 discussions occurred with families before an end of life decision was arrived at.Switching from aggressive care to comfort care was a more common decision-making route than having palliative care from the outset.Ninety per cent of families indicated satisfaction with the decision making process at follow-up and more than half of them returned later to meet with the NICU team.Some concerns were expressed about the availability of neonatologists at weekends.Conclusions A compassionate and humane approach to the family with honesty and empathy creates a positive environment for decision-making.An available,experienced team willing to engage families repeatedly is beneficial.Initiating intensive care with subsequent palliative care is acceptable to families and caregivers.

关 键 词：舒缓治疗 临终关怀 新生儿 

分 类 号：R48[医药卫生—临床医学]