臨終前的皮膚衰竭：甘迺迪末期壓瘡

Skin Change at Life’s End（SCALE）: Kennedy Terminal Ulcers（KTU）

臥床的病人一旦產生壓瘡(俗稱褥瘡)，恢復的過程非常緩慢，常常得歷經手術、清瘡、敷藥等長達幾個月或甚至更久的治療。壓瘡長久以來被認為是照護品質的指標，一旦發生往往會是醫病或護病糾紛的原因，興起訴訟也時有聞。本文藉由病例系列描述，向讀者介紹甘迺迪末期壓瘡。這是一種臨終前皮膚衰竭的特有表現。病人一旦出現這種壓瘡，常常意味著即將走完人生旅程。這時，應以適度的傷口處理來取代積極的手術性介入，並伴隨適度的內科治療或安寧緩和照護的介入，在合理的治療及親愛的家人陪伴中，讓病人安詳離世。

Pressure ulcers often develop on the bed ridden patients who have lost or limited ability to change positions. They usually recover very slowly, even after debridement(s) and long term wound care. They are thought to be an indicator of healthcare quality. Once they occur, lawsuit may sometimes follow. Skin, like any other organ system, may fail near the end of life. This kind of almost irreversible skin breakdown is called Kennedy Terminal Ulcer (KTU) or Skin Changes at Life’s End (SCALE). Once impressed, aggressive surgical intervention is not indicated for such patients and hospice care with standard of wound care is recommended. Herein we report two cases of KTU/SCALE. Both died peacefully and calmly, accompanied by their dearest family members.