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我国麻醉医师对缓和医疗及缓和镇静的认知现状: 一项全国横断面调查

Cognition of Palliative Care and Experience of Palliative Sedation in Chinese Anesthesiologists: A National Cross-sectional Survey

    摘要
  • 摘要:
      目的  初步调查我国麻醉医师对缓和医疗及终末期患者缓和镇静的了解及相关临床能力。
      方法  2021年10—12月，采用便利抽样法，通过中华医学会麻醉学分会在全国麻醉医师中开展横断面问卷调查。问卷内容主要包括社会人口学信息、工作经验、是否熟悉缓和医疗、面对终末期患者的感受、是否给重症/终末期痛苦患者实施过缓和镇静及镇静药物选择。
      结果  来自全国29个省级行政单位的2536名麻醉医师完成了有效问卷，其中仅572名(22.6%，572/2536)医师表示熟悉缓和医疗。男性、有重症/终末期患者接触经历、参与疼痛临床诊疗、医院设立安宁缓和医疗组或相应部门/组织的麻醉医师更熟悉缓和医疗(P均<0.05)。超过40%的麻醉医师面对终末期患者时会感到无力、无助且对临床决策存在困惑，了解缓和医疗的麻醉医师面对重症/终末期患者时信心更足(9.8% 比4.4%，P=0.001)。在734名有缓和镇静实施经验的麻醉医师中，151人(20.6%，151/734)曾仅使用阿片类药物作为镇静手段。
      结论  我国麻醉医师对缓和医疗及缓和镇静药物选择的认识尚不足。加强缓和医疗团队建设、开展缓和医疗及缓和镇静的教育培训或将有助于提高麻醉医师面对重症/终末期患者时的信心，改善终末期患者的诊疗质量。

     

    Abstract:
      Objective  This study aimed to investigate Chinese anesthesiologists' comprehension of palliative care and their experiences with palliative sedation for patients in the end-stage of life.
      Methods  From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The survey questionnaire encompassed general information, professional experience, familiarity with palliative care, emotional responses to end-stage cases, experience with sedation for critically ill or end-stage patients, and preferences for sedation medication.
      Results  A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. Among them, 572 anesthesiologists(22.6%, 572/2536) reported familiarity with palliative medicine. Male anesthesiologists, as well as those with prior experience in caring for critically ill or end-stage patients, involved in pain management and practicing in hospitals with established institutional palliative care teams, demonstrated greater familiarity with palliative care concepts(all P<0.05). Over 40% of respondents felt powerless, helpless, and indecisive when confronted with end-stage patients. Anesthesiologists knowledgeable about palliative care exhibited greater confidence in managing critically ill or end-stage patients(9.8% vs. 4.4%, P=0.001). Among the anesthesiologists surveyed, 734 had administered sedation to end-stage patients, with 151 of them(20.6%, 151/734) inappropriately relying solely on opioids for sedation.
      Conclusions  The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China is still very limited. The establishment of palliative care teams, provision of education and training in palliative care, and enhancement of familiarity with palliative principles may bolster anesthesiologists' confidence when encountering critically ill or end-stage patients and subsequently enhance the quality of care for patients in the terminal stages of life.

     

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