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題名：協助末期病人撤除維生醫療經驗分享--一個案報告
書刊名：安寧療護
作者：沈政廷／戴志融／黃裕雯／錢靜馨／黃洽鑽／吳建誼
作者(外文)：Shen, Cheng-ting／Tai, Chi-jung／Huang, Yu-wen／Chien, Ching-hsin／Huang, Chia-tsuan／Wu, Chien-yi
出版日期：2014
卷期：19:3
頁次：頁296-308
主題關鍵詞：末期病人；撤除維生醫療；家庭會議；安寧療護；Terminal ill patient；Withdrawal of life-sustaining treatment；Family meeting；Palliative care
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(2) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:2
  • 共同引用共同引用:0
  • 點閱點閱:13
近年來，越來越多末期病人選擇接受緩和照護，撤除維生醫療。家庭會議在撤除維生醫療扮演很重要的角色。撤除前和家屬舉行家庭會議、和家屬溝通並讓家屬了解撤除的流程以及如何照護病人，以期給予病人最好的照護。病人為83歲男性，因原發不明腹膜轉移癌併急性腸阻塞、敗血症、急性腎衰竭於加護病房進行血液透析與維生醫療。病人意識保持清醒，但狀況持續未改善，一直無法脫離呼吸器；因此會診安寧團隊介入，與家屬召開家庭會議進行撤除維生醫療討論。家屬尊重病人意願；在家屬的協助和團隊的見證下，病人簽署施行安寧緩和醫療及不施行維生醫療意願書。撤除維生醫療後，病人轉至安寧病房接受緩和照護，在家人的陪伴下，走完人生的最後一段旅程。
In these years, more and more patients in the terminal stage asked to withdraw life-sustaining treatment and chose to receive palliative care. The family meeting plays an important role before withdrawal of life-sustaining treatment. Holding the meeting and communication with the family let them realize the process of withdrawal and palliative care for these patients. The case was a 83-year-old male who was diagnosed as the terminal stage of unknown-origin cancer with metastatic carcinomatosis, with acute ileus, sepsis, and acute kidney injury. He was treated in the intensive care unit with hemodialysis and life-sustaining treatment. His consciousness was clear, but his condition could not get improved at all, and thus it was difficult for him to wean from mechanical ventilation. Hospice care team was consulted and we held the family meeting for discussion about withdrawal of life-sustaining treatment. His family respected the patient’s decision, and then he signed the document of do-not-resuscitate (DNR) and withdrawal of life sustaining treatment. After withdrawal of life-sustaining treatment, the patient was transferred to hospice ward for end-of-life care with his family.
期刊論文
1.蔡甫昌、方震中、陳麗光、王榮德(20120300)。長期呼吸器依賴病患撤除維生治療之倫理法律議題。臺灣醫學，16(2)，156-173。  延伸查詢new window
2.Levin, T. T.、Moreno, B.、Silvester, W.、Kissane, D. W.(2010)。End-of-life communication in the intensive care unit。Gen Hosp Psychiatry，32(4)，433-442。  new window
3.Lautrette, A.、Darmon, M.、Megarbane, B.(2007)。A communication strategy and brochure for relatives of patients dying in the ICU。New Engl J Med，356(5)，469-478。  new window
4.Prendergast, T. J.、Luce, J. M.(1997)。Increasing incidence of withholding and withdrawal of life support from the critically ill。Am J Respir Crit Care Med，155，15-20。  new window
5.Esteban, A.、Gordo, F.、Solsona, J. F.(2001)。Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study。Intensive Care Med，27，1744-1749。  new window
6.Curtis, J. R.、Vincent, J.-L.(2010)。Ethics and end-of-life care for adults in the intensive care unit。The Lancet，376，1347-1353。  new window
7.Braun, U. K.、Beyth, R. J.、Ford, M. E.、McCullough, L. B.(2008)。Voices of African American, Caucasian, and Hispanic Surrogates on the Burdens of End-of-Life Decision Making。J Gen Intern Med，23，267-274。  new window
8.White, D. B.、Braddock, C. H. 3rd.、Bereknyei, S.、Curtis, J. R.(2007)。Toward shared decision making at the end of life in intensive care units: opportunities for improvement。Arch Intern Med，167，461-467。  new window
9.Manara, A. R.、Pittman, J. A.、Braddon, F. E.(1998)。Reasons for withdrawing treatment in patients receiving intensive care。Anaesthesia，53，523-528。  new window
10.Azoulay, E.、Chevret, S.、Leleu, G.(2000)。Half the families of intensive care unit patients experience inadequate communication with physicians。Crit Care Med，28，3044-3049。  new window
11.Gristina, G. R.、De Gaudio, R.、Mazzon, D.、Curtis, J. R.(2011)。End of life care in Italian intensive care units: where are we now?。Minerva Anestesiol，77，911-920。  new window
12.Azoulay, E.、Timsit, J. F.、Sprung, C. L.、Soares, M.、Rusinová, K.、Lafabrie, A.、Svantesson, M.、Rubulotta, F.、Ricou, B.、Benoit, D.、Heyland, D.、Joynt, G.、Français, A.、Azeivedo-Maia, P.、Owczuk, R.、Benbenishty, J.、De Vita, M.、Valentin, A.、Ksomos, A.、Schlemmer, B.(2009)。Prevalence and factors of intensive care unit conflicts: the conflicus study。American Journal of Respiratory and Critical Care Medicine，180(9)，853-860。  new window
13.Fassier, T.、Azoulay, E.(2010)。Conflicts and communication gaps in the intensive care unit。Current Opinion in Critical Care，16(6)，654-665。  new window
14.McDonagh, J. R.、Elliott, T. B.、Engelberg, R. A.(2004)。Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction。Crit Care Med，32，1484-1488。  new window
15.Schneiderman, L. J.、Gilmer, T.、Teetzel, H. D.(2003)。Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial。JAMA，290(9)，1166-1172。  new window
16.Epker, J. L.、Bakker, J.、Kompanje, E. J.(2011)。The Use of Opioids and Sedatives and Time Until Death After Withdrawing Mechanical Ventilation and Vasoactive Drugs in a Dutch Intensive Care Unit。Anesth Analg，112，628-634。  new window
17.Truog, R. D.、Campbell, M. L.、Curtis, J. R.(2008)。Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine。Crit Care Med，36，953-963。  new window
18.Cooke, C. R.、Hotchkin, D. L.、Engelberg, R. A.、Rubinson, L.、Curtis, J. R.(2010)。Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU。Chest，138(2)，289-297。  new window
19.Lai, Chun-fu、Tsai, Hung-bin、Hsu, Su-hsuan、Chiang, Chih-kang、Huang, Jenq-wen、Huang, Sheng-jean(20131000)。Withdrawal from Long-term Hemodialysis in Patients with End-stage Renal Disease in Taiwan。Journal of the Formosan Medical Association，112(10)，589-599。  new window
20.Cohen, L. M.、Germain, M.、Poppel, D. M.、Woods, A.、Kjellstrand, C. M.(2000)。Dialysis discontinuation and palliative care。Am J Kidney Dis，36(1)，140-144。  new window
21.Gordon, D.(2004)。Principles and practice of withdrawing life-sustaining treatment。Crit Care Clin，20，435-451。  new window
圖書
1.Rockville, M. D.(2010)。Shared decision-making in the appropriate initiation of and withdrawal from dialysis, Clinical practice guideline。Renal Physicians Association。  new window
其他
1.安寧照顧基金會，黃勝堅。生命末期撤除維生系統的迷思，http://www.hospice.org.tw/2009/chinese/share-view.php?cate= 1&info=125。  延伸查詢new window
 
 
 
 
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