末期病人撤除維生醫療之經驗分析

Experiential analysis of withdrawal of life-sustaining care for terminal patients

研究目的：本研究旨在分析某區域醫院撤除維生醫療之分析。材料與方法：本文為回溯性研究，收集北部某區域醫院2016年3月至2023年12月符合末期會診安寧共同照護（簡稱安寧共照），撤除維生醫療之病人為對象，分析其過程及結果。結果：共208位病人撤除維生醫療，男性95位，女性113位，平均年齡為83.2±12.1歲，病人疾病以腎衰竭最多達68位，本研究中由家屬簽署不施行心肺復甦術暨維生醫療同意書達187位，撤除項目以氣管內管最多有54位，撤除維生醫療後病人平均死亡時間為4.95 ± 7.8日，撤除後結案原因以死亡佔最多數171位(82.2%)；撤除後未死亡人數共計37位，其中以轉居家安寧13位(6.3%)最多最終收案後平均死亡時間為6.7 ± 8.6日，本院區未設置腫瘤及安寧病房，撤除維生醫療診斷以非癌居多佔83.2%故撤除地點也已病房佔多數，非安寧病房之醫護人員除一般性照顧外，如何以病人為中心的提供靈性方面及臨終照顧等即時性服務，安寧療護如何在非特定場所及有限資源下，讓病人及家屬也能獲得身、心、靈的照護，結果可做為在職教育及非安寧病房病人照護之參考。

 

Objective: This study aimed to analyze the process and outcomes of withdraw-ing life-sustaining treatment (LST) in a regional hospital. Methods and Methods: This retrospective study collected data from patients who met the criteria for pallia-tive shared care and underwent withdrawal of LST at a regional hospital in northern Taiwan between March 2016 and December 2023. The processes and outcomes were analyzed. Results: A total of 208 patients withdrew LST, including 95 males and 113 females, with a mean age of 83.2 ± 12.1 years. The most common underlying disease was renal failure (68 patients). In 187 cases, family members signed the consent form for withholding cardiopulmonary resuscitation and LST. The most frequently withdrawn intervention was endotracheal intubation (54 patients). The average time from LST withdrawal to death was 4.95 ± 7.8 days. The majority of patients (171, 82.2%) died after LST withdrawal, while 37 patients survived, with 13 (6.3%) dis-charged for home palliative care. The average time from LST withdrawal to death for those discharged was 6.7 ± 8.6 days. The hospital or this study does not have dedicated oncology or palliative care units, most LST withdrawals occurred in gen-eral wards, predominantly for non-cancer diagnoses (83.2%). While general nursing care was provided, the delivery of patient-centered spiritual and end-of-life care ser-vices in non-palliative settings with limited resources remains a challenge. The findings can inform in-service education and care for terminally ill patients in non-palliative wards.