开展安宁缓和医疗对生命末期老年病人医疗状况影响的纵向研究  

Effects of hospice and palliative care on medical treatment of end-of-life elderly patients:a longitudinal study

作　　者：刘国樑[1] 郑辉[1] 秦明照[1] 刘谦[1] LIU Guo-liang;ZHENG Hui;QIN Ming-zhao;LlU Qian(Department of Geriatrics,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院老年医学科,北京市100730

出　　处：《实用老年医学》2023年第5期479-482,共4页Practical Geriatrics

摘　　要：目的了解开展安宁缓和医疗(hospice and palliative care,HPC)对生命末期老年病人医疗状况的影响。方法连续查阅2014~2021年我院老年医学科死亡病人的病历,记录一般情况、心肺复苏意愿、生命支持手段的应用及临终前抢救措施。根据开展HPC教育及临床工作的时间(以2018年1月为界点),将病例分为2014~2017年、2018~2021年2组进行纵向研究;并对2018~2021年开展HPC期间的病人进行亚组分析。结果共纳入254例死亡病人:2014~2017年死亡131例,2018~2021年死亡123例。2组年龄、性别、入院时躯体功能状况、1年内住院次数、住院时间、死亡原因构成差异均无统计学意义(P>0.05)。2组口服药物数量、多重用药比例、呼吸机使用率、使用白蛋白情况差异有统计学意义(P<0.05)。2组选择临终前不行心肺复苏及心外按压的比例差异无统计学意义(P>0.05),电除颤、简易呼吸器、血管活性药物、呼吸兴奋剂使用率差异有统计学意义(P<0.05)。2020~2021年与2018~2019年相比,生命末期老年病人多重用药率(37.3%比51.4%,P<0.05)、临终前血管活性药物使用率(49.0%比77.8%,P<0.05)、呼吸兴奋剂使用率(15.7%比50.0%,P<0.05)进一步下降。结论对于老年生命末期病人,开展HPC能够减少部分生命支持手段的使用,降低临终前无效医疗的应用。Objective To investigate the effects of hospice and palliative care(HPC)on medical treatment status of hospitalized elderly patients at the end of life.Methods The medical records of the dead elderly patients from 2014 to 2021 in the Department of Geriatrics of our hospital were reviewed retrospectively.The general information,willingness to cardiopulmonary resuscitation(CPR),application of life-sustaining treatments and end-of-life care measures were recorded.The patients were divided into 2014-2017 group(the patients did not receive HPC,n=131)and 2018-2021 group(the patients received HPC,n=123).Results There were no significant differences in age,gender,physical functional status,times of hospitalization in 1 year,length of hospitalization,cause of death between the two groups(P>0.05).There were significant differences in oral medication number,the proportions of polypharmacy,mechanical ventilation and albumin infusions between the two groups(P<0.05).There were no differences in the proportions of preference of do-not-resuscitate(DNR)and external cardiac compression between the two groups.The differences in the proportions of using electric defibrillation,bag mask ventilation,vasopressors and respiratory stimulant between the two groups were statistically significant(P<0.05).Subgroup analysis showed that the proportions of polypharmacy(37.3%vs 51.4%,P<0.05),using vasopressors(49.0%vs 77.8%,P<0.05)and respiratory stimulant(15.7%vs 50.0%,P<0.05)were further decreased in 2020-2021 compared with 2018-2019.Conclusions For the elderly patients at the end of life,HPC can reduce the application of some life-sustaining treatment and futile medical resource use before death.

关 键 词：安宁疗护 缓和医疗 生命末期 老年人 生命支持 

分 类 号：R48[医药卫生—临床医学]