文章摘要
刘谦,秦明照,周健,陈一文,沈琦,刘伟萍.北京某三甲医院老年科患者生命末期医疗照护状况分析[J].中国临床保健杂志,2019,22(2):156-160.
北京某三甲医院老年科患者生命末期医疗照护状况分析
End-of-life care status in department of geriatrics of a tertiary hospital in Beijing
投稿时间:2018-12-21  
DOI:10.3969/J.issn.1672-6790.2019.02.004
中文关键词: 临终关怀医疗  生活质量  病人意愿  临床决策  老年人
英文关键词: Hospice care  Quality of life  Patient preference  Clinical decision-making  Aged 〖FL
基金项目:北京市科学技术委员会重大课题(D121100004912001)
作者单位E-mail
刘谦 首都医科大学附属北京同仁医院老年医学科、干部医疗科,北京 100730 13522159740@163.com 
秦明照 首都医科大学附属北京同仁医院老年医学科、干部医疗科,北京 100730  
周健 首都医科大学附属北京同仁医院老年医学科、干部医疗科,北京 100730  
陈一文 首都医科大学附属北京同仁医院老年医学科、干部医疗科,北京 100730  
沈琦 首都医科大学附属北京同仁医院老年医学科、干部医疗科,北京 100730  
刘伟萍 首都医科大学附属北京同仁医院老年医学科、干部医疗科,北京 100730  
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中文摘要:
      目的 了解老年科老年患者死亡原因的构成、临床特点、有创抢救措施的意愿以及生命末期的医疗照护状况,为开展安宁缓和医疗工作提供依据。 方法 回顾性连续查阅某三甲医院老年科2014年至2017年年龄≥60岁死亡病历129份,记录患者的临床特征、心肺复苏知情同意签署情况、住院期间维持生命手段的应用情况及临终前医疗照护状况,应用SPSS17.0软件进行统计分析。 结果 男性98例(76.0%),女性31例(24.0%),中位年龄87(82,1)岁,≥80岁110例(85.3%);共病指数(6.9±2.9)分,114例(87.8%)为中重度失能,81例(62.8%)存在多重用药,75例(58.1%)住院时间长于当年科室平均住院日,23例(17.8%)入住重症监护室,78例(62.5%)在生命最后一年多次住院;死亡原因前三位为:恶性实体肿瘤48例(37.2%)、感染性疾病47例(36.4%)、心脏疾病15例(11.6%);决策是否行心肺复苏的签署人中,109例(84.5%)为患者子女,123例(89.0%)不同意心肺复苏;临终前46例(35.7%)接受呼吸机治疗,117例(90.7%)使用血管活性药物,83例(64.3%)使用呼吸兴奋剂;90例(69.8%)使用广谱抗生素,52例(40.3%)接受输血,95例(73.6%)静脉输入白蛋白,97例(75.2%)使用胃管,62例(48.0%)应用静脉营养,8例(6.2%)应用肾脏替代技术,7例(5.4%)和4例(3.1%)分别接受手术和化疗。 结论 老年科生命末期患者死亡原因以恶性实体肿瘤及感染性疾病为主,维持生命的支持手段使用率高,需要推广预立医疗计划、推进安宁缓和医疗工作。
英文摘要:
      Objective To investigate the causes of death,clinical characteristics,preference of invasive treatment and end-of-life care status of older adults in department of geriatrics,so as to provide the data for the hospice and palliative care. Methods A retrospective review was conducted on 129 consecutive death records of patients aged ≥ 60 years old from 2014 to 2017 in department of geriatrics of a tertiary hospital in Beijing.The clinical characteristics,signature of preference of cardiopulmonary resuscitation (CPR),application of life-sustaining treatments and end-of-life care were recorded. SPSS17.0 software was used for statistical analysis. Results There were 98 males (76.0%) and 31 females (24.0%),with median age of 87 (82,1) years old.There were 110 cases (85.3%) were age 80 and above.The mean Charlson Index was 6.9±2.9.There were 114 cases (87.8%) with moderate or severe disability, 81 cases (62.8%) with polypharmacy,23 cases (17.8%) admitted to intensive care unit, 75 cases (58.1%) with hospital stay longer than that of the average,and 78 cases (62.5%) with multiple hospital stays in the last year of life. The top 3 leading causes of death were malignant solid tumors (n=48,7.2%),infectious diseases (n=47,6.4%) and heart diseases (n=15,1.6%). Among the signers who decided whether to perform CPR, 109 (84.5%) were children of the patients, and 123 (89.0%) disagreed with CPR.46 cases (35.7%) were treated with ventilator,117 cases (90.7%) were given vasoactive drugs,83 cases (64.3%) used respiratory stimulants,90 cases (69.8%) received broad-spectrum antibiotics,52 cases (40.3%) received blood transfusion,95 cases (73.6%) received intravenous administration of albumin, 97 cases (75.2%) used nasogastric tube and 62 cases (48.0%) received intravenous nutrition.Renal replacement therapy was used in 8 cases (6.2%),7 cases (5.4%) and 4 cases (3.1%) underwent surgery and chemotherapy respectively. Conclusion The main causes of death of older adults in department of geriatrics are malignant solid tumors and infectious diseases.Children of the patients are the main medical surrogate decision-makers.The rate of life-sustaining treatment utilization is high.Therefore, advance care planning, hospice and palliative care,end-of-life care skills should be promoted.Considering the patients′ preference,focusing on suffering and avoiding futile treatment are the main goals which will improve the quality of life of older adults at the end of life.
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