影響生命末期住院病人簽署“不施行心肺復甦術”內容之相關因素探討; The determinants of “Do-Not-Resuscitation” contents in end-of-life patients in hospital

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題名:	影響生命末期住院病人簽署“不施行心肺復甦術”內容之相關因素探討;The determinants of “Do-Not-Resuscitation” contents in end-of-life patients in hospital
作者:	林亞陵;Ya-Ling Lin
貢獻者:	醫務管理學研究所碩士班
關鍵詞:	生命末期照護;善終;不施行心肺復甦術;End-of-life care;good death;Do-Not-Resuscitation
日期:	2009-06-24
上傳時間:	2009-08-12 16:22:25 (UTC+8)
摘要:	隨著醫療科技進步及各種維生設備的使用，疾病進展到末期階段時，先進的醫療雖可短暫延續生命，卻無法真正滿足病人生命末期的生活品質與提昇生命尊嚴。目的：本研究欲瞭解台灣生命末期住院病人簽署不施行心肺復甦術同意書內容之現況，及分析簽署當時病人醫療狀態與簽署不施行心肺復甦術同意書內容之相關性。方法：本研究採次級資料分析，收集南部某區域教學醫院，2007年1月1日至2008年12月31日期間住院臨終病人病歷資料；已簽署不施行心肺復甦術病人400例為研究對象。蒐集資料以SPSS 統計套裝軟體進行統計分析，以描述性統計簽署不施行心肺復甦術病人人口學特性、醫療狀況。卡方檢定確定簽署不施行心肺復甦術病人人口學特性、醫療狀況、簽署者關係，其對簽署不施行心肺復甦術內容之差異性。進一步以羅吉斯統計法分析探討影響簽署不施行心肺復甦術內容之重要因素。結果：依本研究結果顯示，簽署不施行心肺復甦術時平均年齡68.23 歲（SD＝16.37）；65歲以上佔53.32％。簽署當時病人之意識狀態平均GCS為6.61分；簽署當時與死亡間隔天數平均為7.75天，多屬延遲性簽署。簽署不施行心肺復甦術病人當時病人之意識狀態、年齡與簽署不施行心肺復甦術內容達統計上顯著意義(P<0.05)。簽署當時病人是否放置氣管內管、是否已執行人工呼吸、是否使用強心劑，及住院病房特性(一般病房與加護病房)對簽署不施行心肺復甦術病人內容亦有顯著差異(P<0.01)。以羅吉斯迴歸統計，在控制相關變項下，簽署不施行心肺復甦術病人當時病人是否使用強心劑對簽署不施行心肺復甦術病人內容有顯著影響(P<0.01)。排除已使用任一項維生系統（氣管內插管、急救藥物注射、人工呼吸）病人後，結果顯示簽署者與病人的關係、簽署時與死亡間隔時間關係達統計上顯著意義(P<0.05)。控制相關變項，羅吉斯迴歸分析結果，簽署者與病人關係有顯著之影響(P<0.01)。結論：簽署不施行心肺復甦術內容在生命末期照護，具有影響病人生命末期的生活品質與生命尊嚴顯著相關性。正視面對「不施予心肺復甦術」時的相關問題，以坦然的態度和病人、家屬及醫師共同討論生命末期醫療的處置方式，可幫助病人、家屬做出適當的決策，提供完善的臨終照護。本研究可提供政府及相關單位在推動生命末期病人照護運作時之參考依據。 By the great progress of the medical science and technology and the use of life-support apparatus, the advanced medical treatment can extend the life transiently, but be unable to meet the quality of the patient’s life and promote life dignity at the end stage of the disease. Purpose: The purpose of this study was to show the present conditions of the patients’ or their family signing the document of “Do-Not-Resuscitation (DNR) ”at the end-of-life stage in Taiwan, and to analyze the correlation of the patients’ medical condition between DNR and non-DNR. Method: The methods included secondary analysis, collecting the history records of the patients at end-of-life stage at a regional teaching hospital from Jan.1st, 2007 to Dec. 31, 2008. There were 400 cases who signed the DNR. SPSS suit software was used for statistical analysis, including descriptive statistics, Chi-Square test and Logistic Regression. Result: The result revealed the mean age of the patients signing the DNR is 68.23 years old (SD =16.37). 53.32% of the patients were over 65-year-old. The mean GCS of the patients signing DNR was 6.61. The mean residual life was 7.75 days from signing the DNR to death. The difference of consciousness, age of the patients between whether signing DNR or not is significant (P<0.05). The same significant difference was noted about inserting endotreacheal tube, using ventilator, cardiac stimulator between the two groups (P<0.01). Logistic Regression showed whether using cardiac stimulator was a significant factor (P<0.01). After removing one of the supporting systems (endotracheal tube, ventilator or cardiac stimulator), the residual life and the relationship between the patient and the signer revealed statistical significant (P<0.05). After the control of confound factor, the relationship between the patient and the signer (P<0.01). Conclusion: There were significant effects about the quality of life and life dignity at end stage of disease. Facing the correlated problems of DNR, the frank attitude and communication among the patients, their family and medical team might help the appropriate decision-making and afford the good end-of-left care. This research can offer the government a reference when promoting the end-of-left care.
顯示於類別:	[醫務管理學系暨碩士班] 博碩士論文

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