末期病人臨終侵入性處置與DNR

在臨床工作中，常會面對到臨終的場景。台灣自民國8 9年立法通過安寧緩和條例，迄今大眾對於安寧緩和醫療雖有初步概念，但對於臨終的醫療處置，仍有一些迷思；臨床醫療人員，仍然會面臨末期病人急救無效卻不得不做的困境。本研究分析中部某醫學中心2010至2012年院內死亡案例，分析臨終病人簽署「不施行心肺復甦術」(do not resuscitate, DNR)的比例，以及侵入性處置的情形。結果得到簽署DNR的族群，臨終前平均住院天數無顯著差異(簽署:未簽署= 16.8 : 13.1, p=.114)、加護病房平均住院天數顯著下降(簽署:未簽署=6.3 : 10.5, p<.001)、侵入性處置分數明顯較低(簽署:未簽署=3.23:5.23, p<.001)、平均插管天數(氣管內管留置)亦明顯減少(簽署:未簽署=5.05:8, p<.001)。數據顯示簽署DNR可有效減低臨終的無效醫療，減低病人不必要的受苦。

In clinical practices, the staff members of medical care would deal with the situation of end-of-life. The law of hospice was passed in Taiwan in 2000. The public had been learning about hospice care gradually. However, still some misunderstanding about the invasive managements in end-of-life was found. The staff members of medical care would still perform some life sustaining procedures in patients with end stage disease in the end of life. This study analyzed the patients passed away in a medical center in middle Taiwan, including hospitalization and end-of-life invasive management with/without do-not-resuscitate (DNR) order. Results showed the average day of hospitalization had no significant difference in patients with DNR order (with DNR: without DNR=16.8: 13.1 days, p=.114). The average of intensive care unit (ICU) stay was much less in the DNR group (with DNR: without DNR=6.3:10.5 days, p<.001). The average invasive management score was significant decreasing (with DNR: without DNR=3.23:5.23, p<.001), and the average stay with endotracheal tube insertion was lower in the DNR group (with DNR: without DNR=5.05:8.00, p<.001). The data showed DNR order could effectively decrease futile medical care in end-of-life and the patients’ suffering.