DoCare重症监护临床信息系统在ICU限制/撤除生命支持治疗中的应用  

Application of DoCare intensive care clinical information system in withholding or withdrawing life-support treatment in ICU

作　　者：兰蕴平 曾帆 吴娅秋 王茜 刘蓉安 

机构地区：[1]四川省医学科学院.四川省人民医院重症医学中心SICU,四川成都610072 [2]成都大学附属医院重症医学科,四川成都610081

出　　处：《中国临床研究》2018年第2期220-223,共4页Chinese Journal of Clinical Research

基　　金：四川省卫生和计划生育委员会科研课题(17PJ137)

摘　　要：目的通过DoCare重症监护临床信息系统采集数据,对ICU限制/撤除生命支持患者治疗进行比较。方法选择2015年5月至2017年5月,ICU限制/撤除生命支持患者82例,按采用限制或撤除生命支持治疗分为两组,限制组45例和撤除组37例,比较实施限制/撤除生命支持治疗决策后两组患者的相关临床指标及临床结局。结果家属签署知情同意书("签署")时,限制组血液净化治疗比例明显少于撤除组(22.2%vs 70.3%,P=0.000)。限制组"签署"至死亡/转出时间和ICU住院时间明显长于撤除组[(3.91±1.66)d vs(2.10±1.65)d,P=0.000;(10.54±4.26)d vs(7.65±5.07)d,P=0.006],ICU住院花费明显高于撤除组[(12.80±5.14)万元vs(6.97±4.44)万元,P=0.000],ICU死亡率明显低于撤除组(51.1%vs 78.4%,P=0.011)。两组间疾病严重度、呼吸机和血管活性药物使用比例、入ICU至"签署"时间以及28 d死亡率比较差异无统计学意义(P均>0.05)。结论 DoCare重症监护临床信息系统可为限制或撤除生命支持治疗提供决策,用于ICU实施限制/撤除生命支持治疗切实可行,且可维护终末期患者尊严,减少患者痛苦,节省医疗资源,但尚需相关政策法规的出台与实施,以保障该措施的可行性。Objective To analyze the decision-making for the patients withholding or withdrawing life-support treatment in ICU by the data collected with DoCare intensive care information system. Methods Eight-two patients withholding or withdrawing life-support treatment in ICU between May 2015 and May 2017 were selected. The patients were divided into two groups according to withholding or withdrawing life-support treatment： withholding group（ n = 45） and withdrawing group（ n = 37）. The related clinical indicators and clinical outcomes of patients after implementation of decision-making withholding or withdrawing life-support treatment were compared between two groups. Results During signing the informed consent ＂ sign＂ by the family members,the ratio of blood purification treatment in withholding group was significantly less than that in withdrawing group（ 22. 2% vs 70. 3%,P = 0. 000）. The time from ＂sign＂to death/transfer and the hospital stay for ICU in withholding group were significantly more than those in withdrawing group [（ 3. 91 ± 1. 66） d vs（ 2. 10 ±1. 65） d,P = 0. 000;（ 10. 54 ± 4. 26） d vs（ 7. 65 ± 5. 01） d,P = 0. 006]. The hospitalization expenses for ICU in withholding group was significantly more than that in withdrawing group[（ 12. 80 ± 5. 14） × 104 yuan vs（ 6. 97 ± 4. 44） ×10-4 yuan,P = 0. 000]. ICU mortality in withholding group was significantly lower than that in withdrawing group（ 51. 1% vs 78. 4%,P = 0. 011）. There were no significant differences in disease severity,the ratio of ventilator use and vasoactive drugsuse,the time from entering ICU to ＂sign＂and 28-day mortality（ all P〉0. 05）. Conclusions The DoCare ICU clinical information system can provide the decision-making of clinical treatment for withholding or withdrawing life-support treatment. The implementation of withholding or withdrawing life-support treatment in ICU is practical and feasible,and it can maintain the dignity of the end-stage patients,reduce patient＇s pain an

关 键 词：重症监护病房 DoCare重症监护临床信息系统 生命终末期 限制/撤除生命支持治疗 

分 类 号：R459.7[医药卫生—急诊医学] R48[医药卫生—治疗学]